EFFECTIVENESS COMPARISON BETWEEN TWO KINDS OF PROCEDURES FOR TREATMENT OF TOTALLY DEGLOVED HAND_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUYujie ^1,2 , QUZhigang ² , SUNLetian ² , JIAOHongsheng ² , LIUYaping ² , DINGXiaoheng ² ,  CAOXuecheng ¹

1. Department of Orthopedic and Traumatic Surgery, General Hospital of Jinan Military Command, Jinan Shandong, 250031, P. R. China;
2. the Hand Surgery Center of Chinese PLA, the 401 st Hospital of Chinese PLA;

Corresponding author：

CAOXuecheng, Email: caoxcheng@126.com

Keywords：

Totally degloved hand; Bag-shaped abdominal flap; Toe transfer

DOI：

10.7507/1002-1892.20140214

Video：

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Objective To compare the effectiveness between toe transfer combined with an abdominal flap and bag-shaped abdominal flap for treatment of totally degloved hand. Methods Between January 2005 and January 2012,18 patients with totally degloved hand were treated by two kinds of techniques.Those patients were divided into 2 groups according to the technique.The bag-shaped abdominal flap was used in 8 cases (group A),and toe transfer with a dorsalis pedis skin flap combined with abdominal S-shaped tile-joint subdermal vascular network flaps was performed in 10 cases (group B).There was no significant difference in gender,age,injury cause,injury degree,and interval between injury and operation between 2 groups (P>0.05).The static two-point discrimination (s2PD),grip power of the reconstructed hand,time of returning to work,and active total range of motion (ROM) of the operated finger were compared between 2 groups to assess the effectiveness. Results All flaps and skin grafts survived in 2 groups.One flap suffered vascular crisis at 2 days after operation and survived after surgical exploration in group B.All patients were followed up 12-24 months (mean,16 months).At last follow-up,group B showed a better recovery of s2PD of the thumb and ROM,and shorter time of returning to work than group A (P<0.05),but no significant difference was found in grip power of the reconstructed hand and s2PD of the other fingers between 2 groups (P>0.05). Conclusion The technique of toe transfer combined with an abdominal flap is better than traditional bag-shaped abdominal flap with the advantages of easy dissection,less time of operation,and satisfactory functional recovery.

Citation： LIUYujie, QUZhigang, SUNLetian, JIAOHongsheng, LIUYaping, DINGXiaoheng, CAOXuecheng. EFFECTIVENESS COMPARISON BETWEEN TWO KINDS OF PROCEDURES FOR TREATMENT OF TOTALLY DEGLOVED HAND. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 973-976. doi: 10.7507/1002-1892.20140214 Copy

1.	Adani R,Busa R,Tarallo L,et al.Update on replantation of degloved skin of the hand.Plast Reconstr Surg,2004,114(5):1228-1332.
2.	巨积辉,李建宁,王海文,等.全手皮肤脱套伤的分型和治疗.中国修复重建外科杂志,2012,26(4):453-456.
3.	Seitz IA,Williams CS,Wiedrich TA,et al.Omental free-tissue transfer for coverage of complex upper extremity and hand defects-the forgotten flap.Hand (N Y),2009,4(4):397-405.
4.	Maloney CT Jr,Wages D,Upton J,et al.Free omental tissue transfer for extremity coverage and revascularization.Plast Reconstr Surg,2003,111(6):1899-1904.
5.	Nazerani S,Motamedi MH,Nazerani T,et al.Treatment of traumatic degloving injuries of the fingers and hand:introducing the "compartmented abdominal flap".Tech Hand Up Extrem Surg,2011,15(3):151-155.
6.	车桂文,张发旻,张文聪.腹部合页式皮瓣修复手部多指脱套伤13例分析.中国误诊学杂志,2008,8(18):4512-4513.
7.	Senda H,Muro H,Terada S,et al.A case of degloving injury of the whole hand reconstructed by a combination of distant flaps comprising an anterolateral thigh flap and a groin flap.J Reconstr Microsurg,2011,27(5):299-302.
8.	Kim KS,Kim ES,Kim DY,et al.Resurfacing of a totally degloved hand using thin perforator-based cutaneous free flaps.Ann Plast Surg,2003,50(1):77-81.
9.	隋海明,丛海波,李金晟,等.甲瓣加双"凸"状皮瓣组合移植修复全手皮肤脱套伤.中国矫形外科杂志,2001,8(2):140-141.
10.	王树锋,张高孟,路培法,等.五个组织瓣组合移植修复全手脱套伤伴五指缺损.中华手外科杂志,1999,15(4):225-227.
11.	杨柳春,侯识志,杨柳先,等.双足甲瓣足背皮瓣联合移植修复全手脱套伤.实用手外科杂志,2007,21(4):235.
12.	张全荣,芮永军,许亚军,等.不同构制游离组织组合移植一期修复全手脱套伤.中国骨与关节损伤杂志,2011,26(11):989-991.
13.	洪建军,高伟阳,李志杰,等.手部套脱伤的分型和治疗.中华手外科杂志,2006,22(4):221-223.
14.	施海峰,芮永军,张全荣,等.外伤性拇指缺损的重建.中国骨与关节损伤杂志,2013,28(3):233-234.
15.	Lin CT,Chen LW.Surgical refinements and sensory recovery of using transverse sensate thoracodorsal artery perforator flaps to resurface ring-avulsed fingers.Ann Plast Surg,2014,72(3):299-306.
16.	Doctor AM,Mathew J,Ellur S,et al.Three-flap cover for total hand degloving.J Plast Reconstr Aesthet Surg,2010,63(4):e402-e405.
17.	Krishnamoorthy R,Karthikeyan G.Degloving injuries of the hand.Indian J Plast Surg,2011,44(2):227-236.

1. Adani R,Busa R,Tarallo L,et al.Update on replantation of degloved skin of the hand.Plast Reconstr Surg,2004,114(5):1228-1332.
2. 巨积辉,李建宁,王海文,等.全手皮肤脱套伤的分型和治疗.中国修复重建外科杂志,2012,26(4):453-456.
3. Seitz IA,Williams CS,Wiedrich TA,et al.Omental free-tissue transfer for coverage of complex upper extremity and hand defects-the forgotten flap.Hand (N Y),2009,4(4):397-405.
4. Maloney CT Jr,Wages D,Upton J,et al.Free omental tissue transfer for extremity coverage and revascularization.Plast Reconstr Surg,2003,111(6):1899-1904.
5. Nazerani S,Motamedi MH,Nazerani T,et al.Treatment of traumatic degloving injuries of the fingers and hand:introducing the "compartmented abdominal flap".Tech Hand Up Extrem Surg,2011,15(3):151-155.
6. 车桂文,张发旻,张文聪.腹部合页式皮瓣修复手部多指脱套伤13例分析.中国误诊学杂志,2008,8(18):4512-4513.
7. Senda H,Muro H,Terada S,et al.A case of degloving injury of the whole hand reconstructed by a combination of distant flaps comprising an anterolateral thigh flap and a groin flap.J Reconstr Microsurg,2011,27(5):299-302.
8. Kim KS,Kim ES,Kim DY,et al.Resurfacing of a totally degloved hand using thin perforator-based cutaneous free flaps.Ann Plast Surg,2003,50(1):77-81.
9. 隋海明,丛海波,李金晟,等.甲瓣加双"凸"状皮瓣组合移植修复全手皮肤脱套伤.中国矫形外科杂志,2001,8(2):140-141.
10. 王树锋,张高孟,路培法,等.五个组织瓣组合移植修复全手脱套伤伴五指缺损.中华手外科杂志,1999,15(4):225-227.
11. 杨柳春,侯识志,杨柳先,等.双足甲瓣足背皮瓣联合移植修复全手脱套伤.实用手外科杂志,2007,21(4):235.
12. 张全荣,芮永军,许亚军,等.不同构制游离组织组合移植一期修复全手脱套伤.中国骨与关节损伤杂志,2011,26(11):989-991.
13. 洪建军,高伟阳,李志杰,等.手部套脱伤的分型和治疗.中华手外科杂志,2006,22(4):221-223.
14. 施海峰,芮永军,张全荣,等.外伤性拇指缺损的重建.中国骨与关节损伤杂志,2013,28(3):233-234.
15. Lin CT,Chen LW.Surgical refinements and sensory recovery of using transverse sensate thoracodorsal artery perforator flaps to resurface ring-avulsed fingers.Ann Plast Surg,2014,72(3):299-306.
16. Doctor AM,Mathew J,Ellur S,et al.Three-flap cover for total hand degloving.J Plast Reconstr Aesthet Surg,2010,63(4):e402-e405.
17. Krishnamoorthy R,Karthikeyan G.Degloving injuries of the hand.Indian J Plast Surg,2011,44(2):227-236.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS COMPARISON BETWEEN TWO KINDS OF PROCEDURES FOR TREATMENT OF TOTALLY DEGLOVED HAND

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