Soft tissue avulsion injury to medial left lower leg without any violation to muscle fascia or injury to tendon (Figure 1). Visible superficial vein that is intact but likely thrombosed. No active bleeding. Skin avulsion proximal mid and lateral lower leg (Figure 2).
Traumatic soft tissue avulsion injury to left lower extremity
Complete motor, sensory (tibial, superficial and deep peroneal nerve) and vascular exam (DP and PT pulse). LLE XR to rule out any osseous injuries.
-All were negative in this patient.
Washout and partial closure in ED.
Local field block achieved with 15cc of 1% lidocaine without epinephrine. Wound copiously irrigated with 1L NS mixed with Betadine. Soft tissue and overlying skin approximated distally with 3-0 chromic. Exposed superficial vein tied off with 3-0 Vicryl. Skin edges also approximated proximally. All areas of open wound were dressed with bacitracin and xeroform. Padded with gauze and wrapped with cast padding and ACE. Patient tolerated the procedure well.
Patient was diligently followed up in PRS clinic every 1-2 weeks. Small fibrinous areas were intermittently treated with local debridement and/or silver nitrate. At the 3-month follow-up visit, the wound was closed secondarily with 4-0 Nylon without significant tension. 4-month post-injury, and wound continues to heal as noted in the photo below.