CLASSIFICATION AND TREATMENT OF WHOLE HAND DEGLOVING INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JU Jihui , LI Jianning , WANG Haiwen , HOU Ruixing.

Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215104, P.R.China.;

Corresponding author：

Keywords：

Whole hand degloving injury; Classification standard; Treatment plan

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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 causes
of 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.

Citation： JU Jihui,LI Jianning,WANG Haiwen,HOU Ruixing.. CLASSIFICATION AND TREATMENT OF WHOLE HAND DEGLOVING INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(4): 453-456. doi: Copy

1.	Yang D, Morris SF, Tang M, et al. Reversed forearm island flap supplied by the septocutaneous perforator of the radial artery: anatomical basis and clinical applications. Plast Reconstr Surg, 2003, 112(4): 1012-1016.
2.	Doctor AM, Mathew J, Ellur S, et al. Three-flap cover for total hand degloving. J Plast Reconstr Aesthet Surg, 2010, 63(4): e402-405.
3.	Sukop A, Tvrdek M, Dusková M, et al. Degloving injury—the use of a combination of free fasciocutaneous sensitive flap and pedicle flaps for reconstruction. Acta Chir Plast, 2005, 47(4): 107-111.
4.	Thomas BP, Tsai TM. Primary reconstruction of a degloved hand using multiple toe transfers on a single pedicle and a reversed radial artery flap. J Reconstr Microsurg, 2004, 20(1): 3-6.
5.	Pradier JP, Oberlin C, Bey E. Acute deep hand burns covered by a pocket flap-graft. Long-term outcome based on nine cases. J Burns Wounds, 2007, 6: e1.
6.	Henry M, Levaro F, Masson M, et al. Simultaneous three-flap reconstruction of extensive hand and finger degloving injury: case report. J Reconstr Microsurg, 2002, 18(5): 387-391.
7.	隋海明, 丛海波, 李金晟. 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.
8.	王树锋, 张高孟, 路培法. 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.
9.	寿奎水. 手部皮肤套脱伤的手术选择. 中华手外科杂志, 2006, 22(2): 65-66.
10.	巨积辉, 赵强, 刘跃飞, 等. 足部游离复合组织瓣组合移植修复全手毁损伤及脱套伤. 中国修复重建外科杂志, 2009, 23(10): 1153-1156.
11.	芮永军, 许亚军, 张全荣, 等. 五块游离组织组合移植修复手脱套伤. 中华显微外科杂志, 2007, 30(4): 258-260.
12.	王春书, 王爱国, 马凌, 等. 吻合静脉加负压引流治疗全手掌皮肤脱套伤. 中国修复重建外科杂志, 2010, 24(5): 632-633.
13.	郭建勋, 杨柳春. 应用双足甲瓣与足背皮瓣联合移植修复全手脱套伤. 中华显微外科杂志, 2008, 31(4): 292.
14.	张全荣, 寿奎水, 施海峰, 等. 双侧足趾皮瓣组合移植一期修复手部脱套伤并再造手指. 中华显微外科杂志, 2006, 29(6): 419-421.
15.	侯瑞兴, 王海文, 巨积辉, 等. 双足带有同蒂多叶皮瓣的趾甲皮瓣移植治疗全手皮肤套脱伤. 中华手外科杂志, 2009, 25(1): 32-34.
16.	周礼荣, 李峻, 王伟, 等. 全手或全足皮肤脱套伤的显微外科修复. 中国修复重建外科杂志, 2003, 17(4): 321-323.
17.	庞水发, 常湘珍, 张方晨, 等. 显微外科在手外科的应用与进展. 中华显微外科杂志, 2009, 32(3): 177-180.
18.	潘风雨, 田万成. 手部套脱伤的分型与程序化治疗临床应用研究. 中华手外科杂志, 2008, 24(3): 144-147.
19.	Thomas BP, Katsarma E, Tsai TM. Replantation of total degloving of the hand: case report. J Reconstr Microsurg, 2003, 19(4): 217-220.

1. Yang D, Morris SF, Tang M, et al. Reversed forearm island flap supplied by the septocutaneous perforator of the radial artery: anatomical basis and clinical applications. Plast Reconstr Surg, 2003, 112(4): 1012-1016.
2. Doctor AM, Mathew J, Ellur S, et al. Three-flap cover for total hand degloving. J Plast Reconstr Aesthet Surg, 2010, 63(4): e402-405.
3. Sukop A, Tvrdek M, Dusková M, et al. Degloving injury—the use of a combination of free fasciocutaneous sensitive flap and pedicle flaps for reconstruction. Acta Chir Plast, 2005, 47(4): 107-111.
4. Thomas BP, Tsai TM. Primary reconstruction of a degloved hand using multiple toe transfers on a single pedicle and a reversed radial artery flap. J Reconstr Microsurg, 2004, 20(1): 3-6.
5. Pradier JP, Oberlin C, Bey E. Acute deep hand burns covered by a pocket flap-graft. Long-term outcome based on nine cases. J Burns Wounds, 2007, 6: e1.
6. Henry M, Levaro F, Masson M, et al. Simultaneous three-flap reconstruction of extensive hand and finger degloving injury: case report. J Reconstr Microsurg, 2002, 18(5): 387-391.
7. 隋海明, 丛海波, 李金晟. 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.
8. 王树锋, 张高孟, 路培法. 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.
9. 寿奎水. 手部皮肤套脱伤的手术选择. 中华手外科杂志, 2006, 22(2): 65-66.
10. 巨积辉, 赵强, 刘跃飞, 等. 足部游离复合组织瓣组合移植修复全手毁损伤及脱套伤. 中国修复重建外科杂志, 2009, 23(10): 1153-1156.
11. 芮永军, 许亚军, 张全荣, 等. 五块游离组织组合移植修复手脱套伤. 中华显微外科杂志, 2007, 30(4): 258-260.
12. 王春书, 王爱国, 马凌, 等. 吻合静脉加负压引流治疗全手掌皮肤脱套伤. 中国修复重建外科杂志, 2010, 24(5): 632-633.
13. 郭建勋, 杨柳春. 应用双足甲瓣与足背皮瓣联合移植修复全手脱套伤. 中华显微外科杂志, 2008, 31(4): 292.
14. 张全荣, 寿奎水, 施海峰, 等. 双侧足趾皮瓣组合移植一期修复手部脱套伤并再造手指. 中华显微外科杂志, 2006, 29(6): 419-421.
15. 侯瑞兴, 王海文, 巨积辉, 等. 双足带有同蒂多叶皮瓣的趾甲皮瓣移植治疗全手皮肤套脱伤. 中华手外科杂志, 2009, 25(1): 32-34.
16. 周礼荣, 李峻, 王伟, 等. 全手或全足皮肤脱套伤的显微外科修复. 中国修复重建外科杂志, 2003, 17(4): 321-323.
17. 庞水发, 常湘珍, 张方晨, 等. 显微外科在手外科的应用与进展. 中华显微外科杂志, 2009, 32(3): 177-180.
18. 潘风雨, 田万成. 手部套脱伤的分型与程序化治疗临床应用研究. 中华手外科杂志, 2008, 24(3): 144-147.
19. Thomas BP, Katsarma E, Tsai TM. Replantation of total degloving of the hand: case report. J Reconstr Microsurg, 2003, 19(4): 217-220.

Chinese Journal of Reparative and Reconstructive Surgery

CLASSIFICATION AND TREATMENT OF WHOLE HAND DEGLOVING INJURY

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