Israel Medical Association Journal

Background: Soft-tissue defects of the lower limb pose a reconstructive challenge. Soft tissue loss with exposed bone, tendon, or cartilage often requires free flap reconstruction. Dermal substitutes are used for treatment of extensive burns to replace damaged skin and may be ideal for lower limb reconstruction in selected cases.

Objectives: To present our experience with reconstruction of lower limb wounds using Integra® Bilayer Wound Matrix (Integra LifeSciences Corp., Plainsboro, NJ, USA) and MatriDerm® (MedSkin Solutions Dr. Suwelack AG, Billerbeck, Germany).

Methods: This single center retrospective study comprised 10 patients who underwent reconstruction of extensive tissue defects of the distal lower limbs with dermal matrices and split-thickness skin grafts.

Results: All patients were successfully reconstructed and resumed normal ambulation. Six patients had complete and four partial graft takes that was treated conservatively until full wound healing. Older patients with medical co-morbidities or history of wound infection were more likely to have partial graft take. One postoperative infection was recorded in the study.

Conclusions: Dermal substitutes are easy to apply and safe, show minimal donor site morbidity, provide good functional and aesthetic outcomes, and should be used for reconstruction of complex lower limb wounds.

Background: Selective management of stable patients with anterior abdomen stab wounds (AASWs) has become a gold standard management approach throughout the world. Evidenced-based options for supporting selective management include clinical follow-up, local wound exploration with or without diagnostic peritoneal lavage, diagnostic laparoscopy, and abdominal computerized tomography. The presence of multiple AASWs might signify a more aggressive attack and limit the safety of a selective management approach.

Objectives: To evaluate whether multiple AASWs are associated with an increased risk of intra-abdominal injury requiring emergency surgery.

Methods: We retrospectively reviewed all AASW patients admitted to Assaf Harofeh Medical Center, Zerifin, Israel, and Hillel Yaffe Medical Center in Hadera, Israel, from 2007 to 2015. Patients were divided into two groups based on the number of stab wounds: single or multiple. Data were coded for demographics, severity of injury, presence of intra-abdominal injury, laparotomy rate, length of hospital stay (LOS), length of stay in the intensive care unit (LICU), and survival.

Results: The study included 169 patients. Of these, 143 patients had a single AASW and 26 had multiple AASWs. There were no differences between the groups regarding demographics, severity of injury, intra-abdominal penetration, specific organ injury, LOS, or LICU. There was no difference in the percentage of patients requiring laparotomy. The overall mortality was 2.36% (4/169). There was no significant difference in the mortality rate between the groups (P = 0.11).

Conclusions: The presence of multiple AASWs is not a risk factor for increased frequency and severity of intra-abdominal injury.