1675

C OPYRIGHT Ó 2013 BY T HE J OURNAL OF B ONE AND J OINT S URGERY, I NCORPORATED

Management of Degloving Injuries of the Foot with a

Defatted Full-Thickness Skin Graft
Hede Yan, MD, Shen Liu, MD, Weiyang Gao, MD, Zhijie Li, MD, Xinglong Chen, MD, Chunyang Wang, MD, PhD,
Feng Zhang, MD, PhD, and Cunyi Fan, MD, PhD

Investigation performed at The Sixth People’s Hospital Affiliated to the School of Medicine of Shanghai Jiaotong University, Shanghai, China

Background: Degloving injuries of the foot with involvement of the heel and sole occur relatively rarely but pose an
extreme challenge to the reconstructive surgeon due to the unique anatomy of the foot. Very limited studies are available
regarding the outcomes of reattachment of the degloved skin as a full-thickness graft.
Methods: Twenty-one patients, including eight children and thirteen adults, were treated for a degloving injury of the foot
with an immediate defatted full-thickness skin graft from September 2002 to January 2010. After reattachment to its
original anatomical site, the graft was further secured with multiple sutures and was fenestrated to improve skin graft
incorporation. Traditional dressings were applied. At the time of follow-up, the clinical outcome was graded with use of the
Maryland Foot Score.
Results: Complete incorporation of the graft occurred in ten of the thirteen adults and seven of the eight children (p >
0.05). Follow-up at an average of 32.8 months (range, twenty-four to sixty months) revealed stable wounds in 81%
(seventeen) of the twenty-one patients. All stated that they were satisfied with the cosmetic appearance of the affected
foot. At the time of the last follow-up, seventeen of the twenty-one patients had a good to excellent score according to the
Maryland Foot Score. Sensation restoration in the pediatric group started earlier and progressed faster than that in the
adult group, but all patients obtained at least protective sensation eventually and none complained of cold intolerance in
the foot.
Conclusions: Degloving injuries can be treated successfully with a defatted full-thickness skin graft followed by con-
ventional dressings in both children and adults. This procedure is relatively simple, without the demands of microsurgical
techniques, and can provide good functional and cosmetic results.
Levels of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

D
egloving injuries of the foot with involvement of
the heel and sole are not common 1-6. The specific
anatomy of the foot, which permits sensibility, sta-
bility, and durability, poses a challenge to the reconstructive
surgeon6-8.
Various treatment methods have been employed to
protect vital structures and restore limb function following a
degloving injury of the foot. Since the degloved skin is dead,
many investigators have advocated debridement and covering
the underlying tissue with skin grafts or flaps4,9-11. According to
the ideal tenet of plastic surgery of replacing ‘‘like with like,’’
any reconstruction with alternative tissue is suboptimal.
Waikakul recommended using either venous reanastomosis
or an arterialized venous technique to improve perfusion
of the degloved skin12. However, these approaches are ef-
fective only when the degloved flap is small and not seriously
contused2.
It is generally accepted that degloving injuries can be
managed by defatting and replacing the skin as a full-thickness
graft13. This approach has been described for the management
of degloving injuries of the foot in several case reports 3,4,6.
However, the weight-bearing function of the foot, especially at

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of
any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this
work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no
author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what
is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the
article.

J Bone Joint Surg Am. 2013;95:1675-81 d http://dx.doi.org/10.2106/JBJS.L.01085

 1676
TH E JO U R NA L O F B O N E & JO I N T SU RG E RY J B J S . O RG
d
MA NAG E M E NT O F DEG LOV I NG INJ URI E S O F THE FOOT WITH A
V O L U M E 95-A N U M B E R 18 S E P T E M B E R 18, 2 013
d d
D E FAT T E D F U L L -T H I C K N E S S S K I N G R A F T

TABLE I Demographic Data

Sex Mean Age Associated

Group No. (M/F) (Range) (yr) Comorbidities Cause of Injury Injury Type Injuries

Pediatric 8 5/3 8.9 (4-15) None Road traffic Total degloving: 6 Avulsion of
accident: 7 toes: 5
Wringing injury Partial degloving: 2 Metatarsal
in wheels of fracture: 2
motorbike: 1
Calcaneal
fracture: 1
Adult 13 9/4 32.6 (18-63) Diabetes: 1 Road traffic Total degloving: 8 Avulsion of
accident: 11 toes: 7
Hypertension: 1 Machinery Partial degloving: 5 Metatarsal
accident: 2 fracture: 4
Lower leg
degloving
injury: 2
Total/average 21 14/7 23.6 (4-63) Diabetes: 1 Road traffic Total degloving: 14 Avulsion of
accident: 18 toes: 12
Hypertension: 1 Wringing injury Partial degloving: 7 Metatarsal
in wheels of fracture: 6
motorbike: 1
Machinery Calcaneal
accident: 2 fracture: 1
Lower leg
degloving
injury: 2

the heel and sole, demands that the defatted skin not only act
as wound coverage, but also function with stability and
durability when the individual is walking. To the best of our
knowledge, the detailed outcomes of this treatment ap-
proach for major degloving foot injuries have not been re-
ported after a relatively long period of follow-up in the
literature. We report on a series of degloving injuries of the
foot with involvement of the heel and sole that were treated
with immediate replacement of the defatted full-thickness
avulsed flap.
Materials and Methods
Patients
T wenty-one patients were treated for a degloving injury of the foot from
September 2002 to January 2010. All had sustained either a total or a partial
degloving injury of the foot that involved both the heel and the sole. Patients

Fig. 1
Illustration of the technical procedures. 1. Wound debridement and skin
defatting: radical excision of nonviable tissue and fascia flap transfer to
cover bone or tendon exposure when necessary. The degloved skin is
defatted with use of scalpels (replaced frequently). The skin should be kept
on tension during this process to facilitate defatting. 2. Skin graft appli-
cation: multiple small 1-cm incisions (black arrow) are made to drain any
seroma or hematoma from the recipient bed. The skin graft is further
stabilized with interrupted sutures (white arrow) around the foot after it is
replanted. 3. Bolster dressing: gauze is processed into small balls and
stuffed around the irregular regions topographically, including the ankle,
the medial plantar area, and the metatarsophalangeal joints, to further
secure the skin graft. 4. Padded dressing: cotton pads are applied around
the foot to create a bulky dressing. 5. The limb is immobilized with a
posterior plaster splint for seven to ten days postoperatively.
 1677
TH E JO U R NA L O F B O N E & JO I N T SU RG E RY J B J S . O RG
d
MA NAG E M E NT O F DEG LOV I NG INJ URI E S O F THE FOOT WITH A
V O L U M E 95-A N U M B E R 18 S E P T E M B E R 18, 2 013
d d
D E FAT T E D F U L L -T H I C K N E S S S K I N G R A F T

TABLE II Mid-term Outcomes

Mean Time to
Mean Duration Return to Sensory Evaluation Development
of Follow-up Daily Living 18 Mo of Maryland Foot
Group No. (Range) (mo) (Range)* (mo) Postoperatively† Scar Status Ulceration Score‡

Pediatric 8 34.1 (24-60) 3.6 (2-6) (1) light touch, Scar 0 Excellent: 5
(1) pinprick contracture: 0
SWM: 3.61-4.56 Hypertrophic Good: 2
scarring: 1
Fair: 1
Adult 13 32.0 (25-57) 5.4 (3-10) (2) light touch, Scar 1§ Excellent: 5
(1) pinprick contracture: 0
SWM: 4.31-6.65 Hypertrophic Good: 5
scarring: 2
Fair: 2
Poor: 1
Total/average 21 32.8 (24-60) 4.7 (2-10) (1) protective Hypertrophic 1 Excellent: 10
sensation, scarring: 3
(1) pinprick
SWM: 3.61-6.65 Good: 7
Fair: 3
Poor: 1

*An independent-samples t test showed that patients in the pediatric group returned to daily living activities slightly earlier than the adults (p =
0.030). †The plus signs indicate positive, and the minus sign indicates negative. SWM = Semmes-Weinstein monofilament. The values represent
the range of monofilament sizes that could be sensed in the group. ‡A value of 90 to 100 is excellent; 75 to 89, good; 50 to 74, fair; and <50,
poor. §The patient with diabetes.

who had a large primary skin defect or a secondary skin defect after debride-
ment were not included in this series. The main cause of the injuries was a road
traffic accident, which accounted for eighteen (86%) of the twenty-one injuries;
entrapment in machinery or wringing by the wheels of a motorbike was the
cause in the remaining cases. The associated injuries included six metatarsal
fractures, one calcaneal fracture, two lower leg degloving injuries, and twelve
toe avulsions. The patients were divided according to age into a pediatric group
(range, four to fifteen years old; mean, 8.9 years old) and an adult group (range,
eighteen to sixty-three years old; mean, 32.6 years old). The patient details are
summarized in Table I.
Surgical Techniques
Immediate resuscitation was carried out first, and the patients were prepared
for surgery. All toes were amputated in cases with a total degloving injury. For
those with a partial degloving injury, the toes were salvaged or amputated
depending on their quality of perfusion. In each case, all degloved skin and the
subcutaneous tissue were assessed grossly. Essentially all but the most trau-
matized skin was used, and even skin with obvious friction trauma was pre-
served. The wound was thoroughly debrided. When necessary, local soft-tissue
transfers were performed to cover any small areas of tendon or bone exposure.
With tension applied to the skin to stabilize it, the degloved flap was defatted
with a sharp scalpel and then reapplied as a full-thickness skin graft. The
procedure of defatting the skin to obtain a relatively intact full-thickness skin
graft is crucial for graft incorporation as well as to maximize the functional and
cosmetic outcomes. Multiple stab wounds were made in the grafts to drain
seroma or hematoma from the recipient bed. After being secured to the wound
edges and underlying recipient bed with multiple sutures, the skin grafts were
14
first covered with a bolster dressing around irregular topographic regions
such as the ankle, the arch of the foot, and the metatarsophalangeal joints. Then
a bulky dressing was applied. All limbs were immobilized with a posterior
plaster splint for seven to ten days postoperatively (Fig. 1). If the graft did not
incorporate completely, the superficial portion of the graft was excised tan-
gentially while the viable part of the deep dermis was preserved to allow split-
thickness skin overgrafting at two to three weeks postoperatively.
Outcome Assessments
Complete graft incorporation was considered to have occurred when secondary
skin grafting was not needed; patients who had sustained small areas of graft
loss that healed without further surgical treatment were considered to have
complete graft incorporation. All patients who underwent secondary skin
grafting were described as having partial graft incorporation. All patients were
followed for at least two years (range, twenty-four to sixty months; mean, 32.8
months). Both early and midterm outcomes were analyzed. To evaluate foot
15
function, we used the Maryland Foot Score . On this scale, a value of 90 to 100
is excellent, 75 to 89 is good, 50 to 74 is fair, and <50 is poor.
Source of Funding
There was no external funding source for this study.
Results
C omplete graft incorporation occurred in ten of the thir-
teen adults and seven of the eight children. One adult
developed an infection of the fifth metatarsal head, which
healed after further amputation. The average length of hos-
pital stay was 21.8 days (range, fourteen to thirty-eight days).
Superficial necrosis of the graft required tangential excision
of the necrotic tissue and split-thickness skin overgrafting in
 1678
TH E JO U R NA L O F B O N E & JO I N T SU RG E RY J B J S . O RG
d
MA NAG E M E NT O F DEG LOV I NG INJ URI E S O F THE FOOT WITH A
V O L U M E 95-A N U M B E R 18 S E P T E M B E R 18, 2 013
d d
D E FAT T E D F U L L -T H I C K N E S S S K I N G R A F T

Fig. 2
Fig. 2-A Anterior view of the degloved foot of a four-year-old girl injured by a truck. Fig. 2-B Plantar view of the degloved foot. Fig. 2-C Anterior view
after debridement of the foot and defatting of the skin. Fig. 2-D The degloved skin has been reattached. The arrow points to the incision made for
drainage.

Fig. 3
Twenty-six-month follow-up photographs of the patient shown in Figure 2. Fig. 3-A Dorsal view. The arrow points to an area of hypertrophic scarring around the
dorsolateral aspect of the forefoot. Fig. 3-B Medial view. The arrow points to hypertrophic scarring below the medial malleolus. Fig. 3-C Lateral view. Fig. 3-D
Plantar view. The arrow shows that the heel has an excellent contour.
 1679
TH E JO U R NA L O F B O N E & JO I N T SU RG E RY J B J S . O RG
d
MA NAG E M E NT O F DEG LOV I NG INJ URI E S O F THE FOOT WITH A
V O L U M E 95-A N U M B E R 18 S E P T E M B E R 18, 2 013
d d
D E FAT T E D F U L L -T H I C K N E S S S K I N G R A F T

Fig. 4
The degloved lower leg and foot of a fifty-two-year-old woman who was run over by a truck. Fig. 4-A Medial view. Fig. 4-B Dorsal view showing the defatted
skin. Fig. 4-C Dorsal view after the full-thickness skin graft was reattached. The red arrow points to an additional incision for drainage. Fig. 4-D Plantar view
of the reconstructed foot. The black arrow depicts an additional anchoring suture used to stabilize skin graft.

Fig. 5
Five-year follow-up photographs of the patient shown in Figure 4. Fig. 5-A Dorsal view. Fig. 5-B Medial view. Fig. 5-C Lateral view. Fig. 5-D Plantar view. The
arrow points to the excellent heel contour.
 1680
TH E JO U R NA L O F B O N E & JO I N T SU RG E RY J B J S . O RG
d
V O L U M E 95-A N U M B E R 18 S E P T E M B E R 18, 2 013
d d
three patients. With the numbers available, no significant
difference in the rate of complete graft incorporation or the
length of hospital stay was seen between the adults and chil-
dren (both p > 0.05). The detailed early results are presented
in the Appendix.
Seventeen of the twenty-one patients had stable wounds
at the time of final follow-up. One adult with diabetes ex-
perienced breakdown of the replanted skin around the plantar
aspect of the first metatarsal head. He declined to have a further
amputation proximally and was treated successfully with rou-
tine dressing changes. All twenty-one patients were satisfied
with the cosmetic appearance of the affected foot. Two adults
and one child developed mild hypertrophic scarring in the
ankle area with no limitation of ankle motion or shoe wear. The
children returned to activities of daily living in a mean of 3.6
months (range, two to six months) and the adults, in a mean of
5.4 months (range, three to ten months). At the time of the last
follow-up, seven of the eight children and ten of the thirteen
adults had good to excellent foot function as rated with the
Maryland Foot Score. The detailed results are shown in Table II.
The Semmes-Weinstein monofilament test showed the
development of protective sensation, with a positive response
to the 4.56 monofilament, starting as early as three months
postoperatively in some of the children, while in the adult
group this response mostly occurred at six months postoper-
atively. By fifteen months, six of the eight children and six of the
thirteen adults could sense the 4.31 monofilament (rated as
diminished light touch16). All of the patients had protective
sensation, sensing a monofilament of <5.07, at the time of final
follow-up, and none complained of cold intolerance in the foot.
No more noticeable sensory improvement was recorded after
fifteen months postoperatively (see Appendix).
Case Reports
Pediatric Case
A four-year-old girl was referred to our hospital following an
injury to the right foot when she was run over by a truck. She
sustained a circumferential laceration at the ankle level and
degloving of the entire right foot associated with a nondis-
placed calcaneal fracture (Figs. 2-A and 2-B-). Following soft-
tissue debridement, all of the toes were amputated at the base of
each proximal phalanx. The degloved skin was defatted to
create a full-thickness skin graft, which was sutured back in situ
(Figs. 2-C and 2-D). Complete graft incorporation was ob-
tained. At twenty-six months postoperatively, there was a sat-
isfactory functional and cosmetic outcome despite mild
hypertrophic scarring of the lateral side of dorsum of the foot
(Fig. 3). The child could sense the 4.31 monofilament in the
reattached skin with no signs of ulceration of the sole or heel.
The parents reported that she was typically active for a child of
her age (Video 1 [see Appendix]).
Adult Case
A fifty-two-year-old woman was run over by a truck, which
resulted in extensive degloving of the skin extending from the
left knee down to the level of the metatarsal heads in the plane
MA NAG E M E NT O F DEG LOV I NG INJ URI E S O F THE FOOT WITH A
D E FAT T E D F U L L -T H I C K N E S S S K I N G R A F T
of the deep fascia (Figs. 4-A and 4-B). The avulsed flap was
defatted and applied as a full-thickness skin graft to its original
anatomical location. (Figs. 4-C and 4-D). Complete incorpo-
ration of the graft occurred. At five years, diminished protective
sensation (ability to sense a 4.56 Semmes-Weinstein monofil-
ament) was recorded at the sole and heel, and both the func-
tional and cosmetic results were satisfactory (Fig. 5 and Video 2
[see Appendix]).
Discussion
D egloving injury of the foot is uncommon but serious2,5.
The results of treatment can seriously affect the quality of
the patient’s life. Therefore, all efforts should be made to select
the best reconstructive solution17. Due to the relatively low
incidence of this injury, there are few published reports on
it1-6,10. A review of the literature demonstrated two main ap-
proaches for the management of this injury: local or free
flaps7-11,17-19 or skin grafting1,3,4,6. Although the outcomes of flap
reconstruction have been satisfactory, the approach of using
a full-thickness skin graft tailored from the degloved skin has
the unique advantage of following the golden rule of recon-
struction: ‘‘replace like with like.’’3,4
In the present study, functional and cosmetic results were
found to be satisfactory at the time of final follow-up, at a
minimum of two years. More than eighty percent of the pa-
tients obtained complete skin graft incorporation, and three
patients with partial graft incorporation were treated success-
fully with secondary spilt-thickness skin grafting with no need
for flap transfers. Only one patient (with diabetes) had a per-
sistent foot ulceration. While three patients had hypertrophic
scarring, none complained about this problem and special
shoes were not required. According to the Maryland Foot
Score, the adult with diabetes had a poor result but seventeen of
the twenty-one patients achieved a good or an excellent result.
In general, children are assumed to have a better recovery
potential18 than adults; however, in this small series, both
groups did well.
There is a wealth of mainly retrospective studies dem-
onstrating relatively good-qualitative recovery of sensibility in
skin grafts20-23. In the present study, protective sensation was
seen as early as three months postoperatively in some children.
Although sensation recovery occurred more slowly in the adult
group, all of the patients achieved at least protective sensation
by one year after injury. On the whole, sensation restoration in
the pediatric group was somewhat superior to that in the adult
group. In both groups, no noticeable further improvement in
sensation was observed after fifteen months.
The technique for salvaging the foot by replacing the
degloved skin as a full-thickness graft and employing negative-
pressure dressings has been described and reported to have
good results3,6,24,25. This technique provides a constant con-
forming pressure on the replaced skin, allowing secure contact
with the recipient bed and potentially increasing the incorpo-
ration of the graft. As this technique is easy to apply, and the
postoperative management is simple, it is considered to be
particularly useful in the management of degloving injuries of
 1681
TH E JO U R NA L O F B O N E & JO I N T SU RG E RY J B J S . O RG
d
MA NAG E M E NT O F DEG LOV I NG INJ URI E S O F THE FOOT WITH A
V O L U M E 95-A N U M B E R 18 S E P T E M B E R 18, 2 013
d d
D E FAT T E D F U L L -T H I C K N E S S S K I N G R A F T

the foot6, with graft incorporation rates of 60%24, 100%25, and described in this report are available with the online version of
95%6. It is conceivable that the complex topography of the foot this article as a data supplement at jbjs.org. n
may reduce the success of full-thickness skin grafting in that
area and the negative-pressure dressings may provide an ex-
pedient treatment modality to contribute to better graft in-
corporation. In this series, 81% of our patients obtained Hede Yan, MD
complete graft incorporation after use of conventional dress- Shen Liu, MD
ings, a method comparable with use of negative-pressure Chunyang Wang, MD, PhD
dressings. Therefore, we believe that when negative-pressure Cunyi Fan, MD, PhD
Department of Orthopedics,
dressings are not available or are unaffordable, conventional
The Sixth People’s Hospital
dressings can provide satisfactory results. Affiliated to the School of Medicine of Shanghai Jiaotong University,
As a retrospective study, this investigation had certain 600 Yishan Road, Xuhui District,
limitations. For instance, only twenty-one cases were evaluated Shanghai, China 200233.
and the average period of follow-up was relatively short. In E-mail address for C. Fan: fancunyi888@hotmail.com
addition, the demographic data were not detailed enough to
allow more extensive analyses. Weiyang Gao, MD
Zhijie Li, MD
In conclusion, degloving injuries of the foot can be
Xinglong Chen, MD
managed successfully by using a defatted full-thickness skin Division of Plastic and Hand Surgery,
graft with conventional dressings in both children and adults. Department of Orthopedics,
This procedure is simple and does not require microsurgical The Second Affiliated Hospital of Wenzhou Medical College,
techniques. 109 West Xueyuan Road,
Wenzhou, China 325027
Appendix
Feng Zhang, MD, PhD
A table showing early results, a schematic illustration of Division of Plastic Surgery,
sensation restoration of the affected foot as demonstrated University of Mississippi Medical Center,
by the Semmes-Weinstein monofilament test, and videos 2500 North State Street,
showing the injuries, treatment, and results in the two cases Jackson, MS 39216

References
1. Green H, Silvani SH, Scurran BL, Karlin JM. Degloving injuries of the foot. Case
presentation and review of the literature. J Am Podiatr Med Assoc. 1988 Jul;78(7):372-5.
2. Liu DX, Li XD, Wang H, Qiu KF, Du SX. Reconstruction of total degloving injuries of
the foot in children. J Trauma Acute Care Surg. 2012 Jul;73(1):209-14.
3. Banwell PE, Evison D, Whitworth IM. Vacuum therapy in degloving injuries of the
foot: technical refinements. Br J Plast Surg. 2002 Apr;55(3):264-6.
4. Cáp R, Lochman P, Horyna P, Koudelka J, Klein L. Laceration and degloving injury
of a child’s foot—a case report. Acta Chir Plast. 2009;51(2):45-7.
5. Lai MF. Degloved sole and heel. Med J Aust. 1979 Jun 30;1(13):598-9.
6. Josty IC, Ramaswamy R, Laing JH. Vaccum assisted closure: an alternative strategy in
the management of degloving injuries of the foot. Br J Plast Surg. 2001 Jun;54(4):363-5.
7. May JW Jr, Halls MJ, Simon SR. Free microvascular muscle flaps with skin graft
reconstruction of extensive defects of the foot: a clinical and gait analysis study.
Plast Reconstr Surg. 1985 May;75(5):627-41.
8. Noever G, Brüser P, Köhler L. Reconstruction of heel and sole defects by free
flaps. Plast Reconstr Surg. 1986 Sep;78(3):345-52.
9. Jolly GP, Zgonis T. Soft tissue reconstruction of the foot with a reverse flow sural
artery neurofasciocutaneous flap. Ostomy Wound Manage. 2004 Jun;50(6):44-9.
10. McCabe WP, Kelly AP Jr, Behan FC. Reconstruction of the plantar pad after
degloving injuries of the foot. Surg Gynecol Obstet. 1973 Dec;137(6):971-4.
11. Zgonis T, Cromack DT, Stapleton JJ. Utilizing a crossover reverse sural artery
flap for soft tissue reconstruction of the plantar forefoot after a severe degloving
injury. Int J Low Extrem Wounds. 2007 Jun;6(2):114-9.
12. Waikakul S. Revascularization of degloving injuries of the limbs. Injury. 1997
May;28(4):271-4.
13. Hidalgo DA. Lower extremity avulsion injuries. Clin Plast Surg. 1986
Oct;13(4):701-10.
14. Iacobucci JJ, Stevenson TR. Bolster dressing to support a full-thickness skin
graft. Ann Plast Surg. 1987 Jun;18(6):550-1.
15. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 dis-
placed intraarticular calcaneal fractures. Results using a prognostic computed
tomography scan classification. Clin Orthop Relat Res. 1993 May;(290):87-95.
16. Isik S, Güler MM, Selmanpakoğlu N. Salvage of foot amputation stumps of
Chopart level by free medial plantar flap. Plast Reconstr Surg. 1998
Mar;101(3):745-50.
17. Kuran I, Turgut G, Bas L, Ozkan T, Bayri O, Gulgonen A. Comparison between
sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area.
Plast Reconstr Surg. 2000 Feb;105(2):574-80.
18. Hara H, Mihara M, Iida T, Narushima M, Todokoro T, Yamamoto T, Koshima I.
Blood glucose measurement for flap monitoring to salvage flaps from venous
thrombosis. J Plast Reconstr Aesthet Surg. 2012 May;65(5):616-9. Epub 2011
Dec 08.
19. Basile A, Stopponi M, Loreti A, Minniti de Simeonibus AU. Heel coverage using a
distally based sural artery fasciocutaneous cross-leg flap: report of a small series. J
Foot Ankle Surg. 2008 Mar-Apr;47(2):112-7.
20. Kredel FE, Evans JP. Recovery of sensation in denervated pedicle and free skin
grafts. Arch Neurol Psych. 1933;29(6):1203-21.
21. Davis JS, Kitlowski EA. Regeneration of nerves in skin grafts and skin flaps. Am J
Surg. 1934;24:501-45.
22. Davis L. The return of sensation to transplanted skin. Surg Gynecol Obstet.
1934;59:533-43.
23. Hutchison JTJ, Tough JS, Wyburn GM. Regeneration of sensation in grafted skin.
Br J Plast Surg. 1949 Jul;2(2):82-94.
24. Meara JG, Guo L, Smith JD, Pribaz JJ, Breuing KH, Orgill DP. Vacuum-assisted
closure in the treatment of degloving injuries. Ann Plast Surg. 1999 Jun;42(6):
589-94.
25. DeFranzo AJ, Marks MW, Argenta LC, Genecov DG. Vacuum-assisted closure for
the treatment of degloving injuries. Plast Reconstr Surg. 1999 Dec;104(7):2145-8.