Replantation surgery with vascular anastomosis for treating whole hand degloving injury

Abstract

Objective To report the surgical techniques and clinical efficacy of replantation surgery with vascular anastomosis for treating whole hand degloving injury. Methods Nineteen cases of whole hand degloving injury were treated with replantation combined with vascular anastomosis.The degloved skin was attached back and the skin of the palm and back of the hand was given light compression bandage. Results Complete survival of the replanted degloved skin was seen in 5 cases.Two cases experienced complete necrosis in 1 to 5 fingers and the skin of the palm and back of the hand.Amputation of five digits from the proximal phalangeal level and abdominal flap for coverage of the palm and dorsum of the hand were done.In 6 cases,partial necrosis in the fingers occurred and these fingers were amputated.In another 6 cases,partial skin necrosis occurred in the palm or the back of the hand and another repair surgery with skin flap was carried out.After 6 to 84 months' follow-up,for 5 cases with complete survival,the hand function such as flexion and extension was satisfactory.For two cases with complete necrosis,the hand function was completely lost.For the other cases,the function of the hand was partially recovered.Sensory recovery in the fingers ranged S2 to S4 and sensory recovery from S1 to S3 was achieved in the skin of the palm and back of the hand. Conclusion Satisfactory therapeutic effect can be obtained when using replantation strgery with vascular anastomosis for treating whole hand degloving injury as long as the surgical indications were appropriate. Key words: Hand injuries; Microsurgery; Degloving injuries; Replantation