Modified Negative Pressure Wound Therapy (NPWT) and Prophylactic Lymphovenous Anastomosis (LVA) in the Early Management of Open Degloving Injury

Abstract

Degloving injuries disrupt perforating vessels and lymphatics, making early viability assessment difficult and predisposing patients to hematoma, seroma, persistent cavities, and posttraumatic lymphedema. We report a 19-year-old male with a 180-degree open thigh degloving injury managed with quilting sutures and a modified negative pressure wound therapy technique using perforated Nelaton catheters to enhance drainage and dead-space collapse. On postoperative day 22, prophylactic lymphovenous anastomosis (LVA) guided by indocyanine green lymphography was performed. Fluorescence accumulation indicated lymphatic disruption and guided exploration of adjacent lymphatic channels suitable for LVA. At 6 months, limb symmetry was restored with no evidence of lymphedema, seroma, chronic posttraumatic fluid collection, or capsule formation, and healing was uneventful. This case demonstrates the potential value of incorporating preventive lymphatic microsurgery into the early management of extensive soft tissue avulsion injuries. Further studies are needed to define indications and long-term outcomes.