Login to Download
PDF version

Index: WOUNDS 2011;23(8):E21–E26.

  Abstract: Various methods have been developed to treat wounds produced from a number of causes. Unavoidable limitations associated with each treatment have encouraged researchers to explore new ways to close wounds rapidly and effectively, while simultaneously obtaining satisfactory outcomes. Produced through interdisciplinary research, dermal substitutes provide a potential solution for solving this problem. Here, we report the case of an open fracture wound accompanied by a skin defect caused by a crush injury of the left foot in which satisfactory results were ultimately achieved. This case is of special interest due to the rarity of the treatment. This case demonstrates that satisfactory results can be obtained in the treatment of a skin defect wound caused by contusion or crush injury associated with fracture using a PELNAC dermal substitute.

  Traumatic injuries are fairly common occurrences that affect patients not only physically, but also psychologically. Rapid and effective closure of traumatic wounds is critically important to prevent infection and facilitate speedy rehabilitation.¹ Autologous split-thickness grafts have been a useful part of the armamentarium for the closure of such wounds.² However, historically, such graphs have resulted in problems, such as severe scarring and a relatively unsatisfactory donor site. Such drawbacks have encouraged the development of skin replacement materials.^3,4

  Dermal substitutes represent a successful outcome of interdisciplinary research being applied to reconstructive surgery.⁵ Their discovery has aroused great interest and received good cosmetic and functional results.⁶ Despite abundant literature on wound closure with dermal substitutes, there is a dearth of information regarding the treatment of skin defects complicated by multiple fractures that are treated with dermal substitutes. The following reports an interesting case of successful reconstruction of a skin defect of the foot with multiple fractures using a PELNAC dermal substitute and conventional autografts.

Case Report

  On October 16, 2009, a 24-year-old woman was transferred from a regional hospital (Dehui Peoples Hospital, Jilin Province, China) for management of a severe and complicated injury. The woman sustained a crush injury to her left foot from a tractor wheel when she was helping her family harvest corn. After the injury occurred, the woman was rescued immediately by her family and transported to the hospital where she was examined and an x-ray of her left foot was obtained. Multiple fractures of the left foot were observed, and the patient was transferred to the authors’ hospital for definitive treatment.

  A careful physical examination was performed, which revealed that the wound was spindled and transverse across the dorsum of the left foot. The examination further revealed extensive contamination of soft tissues and exposed bone fragments. In addition, major vessels and nerves were severely contused, though still in continuity. The patient reported a significant amount of pain in response to palpation of the second and third metatarsal bones, as well as the fifth toe. The patient’s foot was cool, and the skin on the foot was dark, as a result of the contusion and avulsion (Figure 1).