Treating a subtotal degloving ring avulsion with leeches: an unusual case report with review of the literature

Abstract

Subtotal deglovement injuries with delayed presentation give rise to the question: how to treat the mangled soft tissue to best keep the digit alive and functioning. We hereby present a case of a 59-year-old woman who was referred to our clinic 7 h after initial trauma from a peripheral hospital where an instant repositioning of a subtotal degloved skin envelop of her left middle finger had taken place with only minimal adhesion and circulation at the top of the finger left intact. On X-ray, a small avulsion fracture of her distal interphalangeal joint was visible but flexion and extension was intact at proximal interphalangeal (PIP) joint level on examination. On arrival, we saw a finger with minimal reconstituted blood circulation and livid skin. Further treatment consisted of onsite debridement and primary suturing of the involved skin, followed by leech therapy the next week, and consecutive split-skin grafting 6 weeks later to cover minor residual defects. Further clinical course was uneventful and showed good clinical and esthetic results. We hereby present the patient’s clinical outcome and review of the literature for further evidence of our treatment regime.Level of evidence: Level V, therapeutic study.