In a case of severe skin avulsion of the lower extremity associated with open injuries of the knee and ankle joint, treatment combining several modes of therapy resulted in a cosmetically acceptable and useful limb. This was achieved operatively by thorough wound cleansing, defatting of the avulsed skin, and circumferential grafting to reappose the sagging musculature. Postoperative care included the use of continuous skeletal wire elevation, continuous irrigation and suction of the joints, and intermittent hyperbaric oxygen therapy.
Keagy RD, Head JR, Kroft AE. Severe Avulsion Injury of the Lower Extremity Skin. JAMA. 1968;206(7):1567-1568. doi:10.1001/jama.1968.03150070105026