OBJECTIVE: To explore a new surgical management of multiple fingers degloving injury. METHODS: In 1994 to 1997, 47 cases with multiple fingers degloving injury were sutured by two reverse "s"-type skin flaps on abdominal flank. RESULTS: The skin flaps in 46 cases survived and the wounds obtained primary heal. CONCLUSION: The application of abdominal flank "s"-type skin flap is reliable and convenient in the treatment of multiple fingers degloving injury.
OBJECTIVE In order to solve the difficult problem of one-stage repair of degloving injury of multiple fingers, the common pedicled ilio-inguinal-hypogastric subdermal vascular network skin flap was designed and the multi-lobes skin flap was performed subsequently. METHODS From 1993 to 1996, there were 5 cases with degloving injuries of multiple fingers were treated by this flap. There were 2 males and 3 females and the age ranged from 7 to 19 years old. RESULTS After operation, the pedicles of the flap was detached between 12 to 16 days and all of the flaps survived completely. Patients were followed up for 6-18 months. After repair, the contour and skin colour of the digits were excellent, and the motion of the interphalangeal joints and skin sensation were good. CONCLUSION The conclusion was as follows: The newly designed skin flap was characterized by the advantages of duration of treatment being short, excellent contour and more rapid recovery of function. It could be used for one-stage repair of degloving injury of multiple fingers.
Objective To evaluate the cl inical efficacy of akin united flaps pedicled with dorsal carpal branch of ulnar artery in repairing compl icated degloving injuries of the opposite fingers. Methods Between August 2005 and August 2009, 11 cases of compl icated degloving injuries of single finger were treated, including 8 males and 3 females with an average age of 26 years (range, 19-55 years). The defect locations were thumb in 1 case, index finger in 7 cases, and middle finger in 3 cases, including 9 cases of mechanical injury and 2 cases of traffic accident injury. The extent of skin avulsion was the proximal segments or beyond the middle segment of finger with a defect range from 5.0 cm × 4.5 cm to 8.0 cm × 5.5 cm. Compl icated injuries included phalangeal fracture in 2 cases, extensor tendon injury in 3 cases, flexor and extensor tendon injuries in 1 case, digital vascular injury in 9 cases, and digital nerve injury in 6 cases. The time from injury to operation was 2-18 hours (mean, 4.8 hours). The akin united flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery. The proximally pedicled flaps enclosed palmar finger, and the distally pedicled flaps enclosed dorsal finger. The size of flaps ranged from 10 cm × 3 cm to 16 cm × 3 cm. The donor sites were sutured directly. After 3 weeks, the pedicle was cut. Results Light yellow secretion and eczema on the flap were observed in 1 case at 3 days, were cured after 2 weeks of dressing change; other flaps survived and healing of incisions by first intention was achieved. The incisions at donor sites healed by first intention. The secondary plastic operation was performed in 2 cases because of bulky flaps at 3 months after operation. Eleven patients were followed up postoperatively 6-12 months (8 months on average). The texture and appearance of all the flaps were satisfactory. The two-point discrimination was 12-20 mm with satisfactory recovery of finger function at 6 months after operation. According to Jebsen standard, the results were excellent in 8 cases, good in 2 cases, and poor in 1 case. Conclusion With rel iable blood supply, easy dissection, less injury at donor site, and good repair results, the akin united flaps pedicled with dorsal carpal branch ofulnar artery is a good method to repair complicated degloving injuries of the opposite fingers.
Repairing degloving injury of fingers by transplantation of ateriolized venous network flap with sensory nerve for six cases (7 fingers). The flaps were all gotsurvived. The procedure of the operation was performed as following: 3～5 supperficial veins and the medial or lateral cutaneous nerve were separated on the palmar side of the forearm as pedicle. According to the defect, the corresponding flaps was designed and was transferred to the injuried finger. Anastomosed the veins with the two digital arteries and veins. Anastomosed the cutaneous nerve with the digital nerves. The patients were followed up for two years. The flaps were soft and wearresisting. The joint movements of the fingers were normal. The twopoints discrimination was 5 to 10mm. The contour of the fingers was satisfactory. The procedure has the following advantages: 1. carried out one operation; 2. good sensation, 3. good appearance and satisfactory function. The indications and factors affecting the survival of the flap were discussed.
In extensive frictionavulsion injuries, part of the injuried skin was still viable, so that total excision of the avulsed skin should be avoided. After debridememt, sutured the avulsed skin flap in situ temporarily and took a split-thickness graft from it. If bleeding occurred from the splitted surface of the dermis which was meant that part of the skin was alive. Along the border between the bleeding and nonbleeding area, the nonbleeding area of skin was excised. This could preserve the viable skin to the maximal extent. From July 1991 to May 1992, the viability of the skin in 8 avulsion injuries was judged. The maximal avul sed area was 13% and the minimal was 6% of the total body surface. After the treatment, 90% of the avulsed skin was alive. The appearance was satisfactory.
Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.