Repurposing Avulsed Skin as a Primary Full Thickness Autograft in Extensive Lower Limb Degloving: A Case Report

Degloving injuries involve the traumatic separation of skin or underlying tissues from their respective bone structures, typically resulting from high-energy mechanisms such as road traffic accidents. The hallmark of these lesions is the avulsion of septal and muscular perforators, which devascularizes the skin envelope and may lead to delayed full-thickness necrosis or limb loss if mismanaged. Historically, these injuries require staged procedures to replace the skin; however, this case report highlights the role of primary full-thickness skin grafting (FTSG) using repurposed tissue performed during the primary debridement. By carefully defatting and converting degloved skin into a graft, surgeons can provide a viable pathway for early definitive coverage.

A 64-year-old male presented following high-energy mechanisms, such as a road traffic accident, with a Tscherne Grade III extensive degloving injury of the right lower limb, measuring 35 × 15 cm and involving 60-70% of the limb circumference. Following stabilization with an across-knee external fixator and radical surgical debridement, a Morel-Lavallee lesion was identified. Skin regions with clinically doubtful vascularity were excised, defatted, and repurposed as a primary full-thickness autologous graft. Although a marginal necrosis involving 20-30% of the graft required a split-thickness skin graft, the final functional and esthetic outcomes were excellent with a reduction in pain over time. Progressive epithelialization was observed during follow-up, with complete epithelial cover achieved by the 3-month visit.

Repurposing avulsed tissue into a primary FTSG provides a practical alternative to the conventional multistage reconstruction. This approach provides early wound stabilization while minimizing the need for repeated surgeries.