From Liability to Viability: Salvage of a Lower-limb Shearing Injury Using a "Spare-part" Graft from Chemically...

Shearing injuries are complex traumatic wounds that present major reconstructive challenges. These are particularly difficult in low-resource settings where access to microsurgical techniques, negative pressure therapy, or skin substitutes is limited. These challenges are compounded when the avulsed skin has been chronically exposed to unregulated skin-lightening agents. Products containing hydroquinone, corticosteroids, or mercury compromise skin integrity and healing capacity. This case report presents a novel application of chemically compromised, avulsed skin as a full-thickness skin graft (FTSG) in a 30-year-old Somali woman following a road traffic accident. The patient sustained a large noncircumferential shearing injury of the right leg. On examination, the avulsed skin appeared thin, hypopigmented, and atrophic. This is consistent with chronic skin bleaching. In the absence of systemic injuries, the surgical team opted to salvage the avulsed tissue. After thorough debridement and irrigation of the wound bed, the compromised skin was immediately defatted, meshed, and reapplied as a full-thickness skin graft. We secured the graft with staples and a bolster dressing. The limb was immobilized. On the first, second, and tenth-week follow-ups, the graft demonstrated good take, progressive epithelialization and stable pigmentation. There were no signs of infection, graft loss, or contracture. This case illustrates the potential utility of chemically altered, avulsed skin as an autologous graft source. It underscores the importance of surgical adaptability, careful preoperative and intraoperative assessment, and pragmatic innovation in trauma care under challenging clinical settings. Further studies are needed to define criteria for safe use of chemically compromised skin in reconstructive surgery.