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Eur J Pediatr Surg 2013; 23(05): 359-364
DOI: 10.1055/s-0033-1353493
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Management of Avulsion Injuries

Sophie Boettcher-Haberzeth
1   Pediatric Burn Center, Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
2   Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
,
Clemens Schiestl
1   Pediatric Burn Center, Division of Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
› Author Affiliations
Further Information

Publication History

11 July 2013

16 July 2013

Publication Date:
27 August 2013 (online)

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Abstract

The optimal management sequence to treat avulsion injuries in children is particularly difficult because of the following problems: (1) Assessment of these rare but frequently massive injuries can be very difficult and treacherous, as the extent of the injury is often underestimated and treatment therefore considered inappropriate; (2) Avulsion injuries have a high risk of infection: lesions are always contaminated due to the mechanism of injury (mostly vehicle accidents) and subsequent long-term hospitalization adds an additional risk for nosocomial infections; (3) Children with avulsion injuries have an increased risk to develop functional deficits: although the body grows, scars and reconstructed tissues may not adapt sufficiently and this may lead to serious constraints. Because of these problems, avulsion injuries may lead to a high morbidity and even mortality, especially if the injury is mismanaged. Reviewing the most recent data regarding the management of avulsion injuries yields the following key points: (1) A scoring system may help to assess the primary dimension of the defect; (2) Innovative techniques such as the use of a Vacuum Assisted Closure system may lower the risk of infection; (3) Choosing a comprehensive, reconstructive approach taking the growth of the child into consideration, may reduce the development of serious functional deficits and improve cosmetic outcome.

Keywords

avulsion injury - children - Vacuum Assisted Closure system - Integra Dermal Regeneration Template
 

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