Repair of degloving injury of the entire hand by bilateral combined transfer of wrap-around flap and multi-petal pedal flaps based on a single pedicle

Abstract

Objective To explore a new operative method of repairing degloving injury of the entire hand by composite transfer.Methods A total of 3 cases of hand degloving injuries were treated with flap transfers from bothfeet.Wrap-around flap from one foot combined with anterior ankle flap,dorsal pedal,medial pedal and lateral pedal flaps all based on the anterior tibial artery were transferred to reconstruct the thumb and cover skin defects of the web space and the thumb and radial side of the hand.The second toe combined with abovementioned pedal flaps were harvested from the other foot and transferred to reconstruct the index or middle finger and cover skin defects on the ulnar side of the hand.Results All the skin flaps survived postoperatively,except necrosis of a reconstructed index finger.Follow up ranged from 3 to 12 months.The appearance of the hand and functions such as pinch.grasp and grip recovered essentially.The sensation of the flaps and reconstructed digits returned to S2 to S4.Conclusion Combined transfer of wrap-around flap and multi-petal flaps based on one pedicle from both feet is an effective way to repair degloving injury of the entire hand. Key words: Hand injuries; Tissue transplantation; Mierosurgery; Degloving injuries