Abdominal Skin Flap Research Articles

Necrostatin-1 protects against ischemia/reperfusion injury by inhibiting receptor-interacting protein 1 in a rat flap model

The failure of reconstructive surgeries remains a challenge for plastic surgeons. Ischemia reperfusion (I/R) injury is considered to be one of the major problems in flap surgery. Necroptosis is a recently discovered and caspase-3-independent programed necrosis. Necrostatin-1 (Nec-1) is a specific inhibitor of necroptosis. Reports indicate that Nec-1 provides protection in ischemic models, such as brain, kidney, and heart. The aim of this study is to investigate the influence of Nec-1 on the I/R process in rat abdominal skin flaps. Twenty male Sprague-Dawley rats, weighing 280-320 g, were randomly divided into three groups. The extended epigastric skin flap (6 cm × 9 cm) of rats was used. Three hours of complete ischemia was performed using a clamp, and the clamp was then removed to reperfusion the flap. Twenty-four hours after the onset of the reperfusion, the rats were assessed for flap survival and perfusion analysis. One sample (1 cm × 1 cm) was taken for H&E, TUNEL, electron microscopy, IHC staining for RIP-1, and ELISA analysis for caspase-3 activity. Compared to the CTL group, the flap in the Nec-1 group showed a higher survival rate and better blood perfusion. In histological observation, skin flap in the Nec-1 group showed less inflammatory infiltration than the CTL group. The AI in the CTL group was higher than that in the Nec-1 group and showed typical morphological changes of apoptotic cells. In IHC study, RIP-1 expression was higher in the CTL group. But there was no significant difference between the two groups in caspase-3 activity detection. Nec-1 has a protective effect against I/R injury through the inhibition of RIP-1 on the skin flap model; this makes it a promising novel strategy in clinical setting.

Neoumbilicoplasty with a Superiorly Based Abdominal Skin Flap.

Summary:We propose a neoumbilicoplasty technique that can be applied when the umbilical stalk becomes disrupted during an abdominoplasty. This case used surgical concepts that involved progressive thinning of the flap in a 3-cm radius around the neoumbilicus, with increased thinning toward the neoumbilical position. This was followed with suture tacking of the thinned abdominal flap to create a concavity around the neoumbilicus. A longer “U” shaped incision was created and also sutured down to abdominal wall to recreate an umbilical “floor” with the adjacent skin sutured to the superior-based flap to construct the walls of the neoumbilicus. An aesthetically pleasing umbilicus resulted with high patient satisfaction and a lack of postoperative complications. There were no additional scars extending beyond the umbilical region.

Reconstruction of the Hand Defects by Pedicled Abdominal Thin Skin Flaps

Reconstruction of the Hand Defects by Pedicled Abdominal Thin Skin Flaps

Novel Injury Site Targeted Fusion Protein Comprising Annexin V and Kunitz Inhibitor Domains Ameliorates Ischemia-Reperfusion Injury and Promotes Survival of Ischemic Rat Abdominal Skin Flaps

The effects of ANV-6L15 on survival of rat abdominal fasciocutaneous flaps subjected to 10 hours of critical ischemia were assessed on day 5. Near-IR imaging was applied to evaluate the distribution of ANV-6L15 and flap perfusion. The rat cremaster muscle island flap was used to evaluate the effect of ANV-6L15 on IRI-induced leukocyte-endothelial interactions via intravital microscopy. 2,3,5 triphenyl-tetrazolium chloride assay was used to determine the ratio between live-versus-dead tissue. ANV-6L15 significantly increased the ratio of viable tissue (68.5 ± 9.79% vs 84.8 ± 5.14%, P < 0.05), and promoted survival of rat pedicled abdominal flaps (59.3 ± 6.86 vs. 47.0 ± 8.67, P < 0.05). Intravital microscopy demonstrated a significant decrease in the number of adhesive leukocytes (1.8 ± 1.64 vs. 10.0 ± 6.32, P < 0.05), and the percentage change of functional capillaries (16.4 ± 15.1 vs. 47.3 ± 18.3, P < 0.05) in ANV-6L15-treatment group. ANV-6L15 promoted survival of ischemic rat cremaster muscle and abdominal fasciocutaneous flaps and ameliorated leukocyte-related IRI. Future evaluation of potential clinical application of ANV-6L15 is warranted as a flap treatment adjunct.

Effects of 4-phenylbutyrate on the ischemia-reperfusion injury of rat skin flaps by inhibiting endoplasmic reticulum stress

Objective To observe the effects of 4-phenylbutyrate (4-PBA) on the ischemia-reperfusion injury of rat skin flaps by inhibiting endoplasmic reticulum stress. Methods Seventy-five Wistar rats were used to create the abdominal island skin flaps. They were then randomly divided into three groups: control group, 4-PBA group and saline group (NC group). In NC and 4-PBA groups, a skin flap tissue sample was removed at the time the skin flap was created 0, 1, 6, 12 and 24 hours following ischemia reperfusion. In the control group, a skin flap tissue sample was removed at the time the skin flap was created 0, 1, 6, 12 and 24 hours following the surgical procedure. Pathological observation, detection of apoptosis by TUNEL method, RT-PCR detection of the expression level of GRP78 and CHOP mRNA, Western-blot and immunofluorescence staining for expression level of GRP78 and CHOP proteins were carried out. The correlation was analyzed. Results Histology showed that the tissue swelling degree, necrotic cells and inflammatory cells in NC group was more severe than 4-PBA group following 6 hours of ischemia and reperfusion. The number of TUNEL positive cells in 4-PBA group, compared with NC group, were reduced by 19.4% and 26.1%, respectively, following 6 and 24 hours of ischemia and reperfusion with significant difference (P<0.05). The levels of both mRNA and protein expression of GRP78 and CHOP were lower in 4-PBA group than NC group following 6, 12 and 24 hours of ischemia and reperfusion with significant difference (P<0.05). Conclusion 4-PBA reduces cell apoptosis in rat skin flaps following ischemia-reperfusion injury by inhibiting endoplasmic reticulum stress-mediated apoptosis mechanism. It plays an important role in protecting rat skin flaps against ischemia reperfusion injury and apoptosis. Key words: Surgical flaps; Animal experimentation; Ischemia reperfusion injury; Endoplasmic reticulum stress; 4-phenylbutyrate

A Case Study of Abdominal Pedicle Skin Flap Repairing and Early Intervention to the Patient who Suffered from Severe Hot Crush Injury in Hand

A Case Study of Abdominal Pedicle Skin Flap Repairing and Early Intervention to the Patient who Suffered from Severe Hot Crush Injury in Hand

Cytotoxic T Lymphocyte–associated Protein 4 Acts on Local Draining Lymph Nodes in the Allogeneic Abdominal Skin Flap of a Rat Model to Extend Its Survival

BackgroundEarly acute allograft rejection is the result of immune cells mainly composed of thymocyte (T) cells, which are activated, mature, and differentiate in lymphoid tissue. MethodsCytotoxic T lymphocyte–associated protein 4 immunoglobulin (CTLA4-Ig) competitively suppresses the cluster of differentiation 28/CTLA4-B7 costimulatory signaling pathway and alters the ratio of T helper 1 to T helper 2, leading to the inhibition of T cell activation. ResultsWe used lentivirus-packed CTLA4-Ig to infect the local draining lymph nodes of the allograft skin flap in a rat model, which effectively extended the survival of the allograft. Meanwhile, it also reduced the dose of immunosuppressant necessary in the early stages of transplantation, which lowered the toxicity and side effects of the drug. ConclusionsOur findings provide new insights into transplantation immunology, facilitate the exploration of a safe and effective immunosuppressive therapy, and promote the wide clinical application of composite tissue allotransplantation.

Chlorogenic Acid Enhances Abdominal Skin Flap Survival Based on Epigastric Artery in Nondiabetic and Diabetic Rats.

Previous studies showed that chlorogenic acid (CGA) accelerates wound healing via its antioxidant activity. We aimed to investigate the effect of CGA in an experimental epigastric abdominal skin flap model in nondiabetic and diabetic rats. Rats were firstly divided into 2 groups: nondiabetic and diabetic. Diabetes was induced by streptozotocin. Then, 4 subgroups were created for each group: vehicle as well as 0.2 mg/0.5 mL, 1 mg/0.5 mL, and 5 mg/0.5 mL CGA treatments. Right epigastric artery-based abdominal skin flaps were elevated and sutured back into their original position. Chlorogenic acid or vehicle was injected once into the femoral arteries by leaving the epigastric artery as the single artery feeding the flaps during the injection. On postoperative day 7, flap survivals were evaluated, and the rats were killed. Distal flap tissues were collected for histopathological and biochemical assays. Chlorogenic acid showed greater flap survival in both nondiabetic and diabetic rats. Capillary density was increased, and necrosis was reduced in the CGA-treated rats. Chlorogenic acid decreased malondialdehyde levels as well as increased reduced glutathione and superoxide dismutase levels in the flap tissues. This study showed that CGA significantly improved flap survival by its antioxidant activities with intra-arterial local injections.

Use of αv Integrin Linked to GFP to Image Molecular Dynamics in Trafficking Cancer-Cell Emboli.

Human osteosarcoma cells with an αv integrin green fluorescent protein (GFP) fusion gene were previously established and imaged in vitro and in vivo. In the present study, we imaged the interaction of αv integrin-GFP in osteosarcoma cells and collagen fibers in vascular-trafficking osteosarcoma emboli in nude mice. Human 143B osteosarcoma cells, expressing αv integrin-GFP, were injected by a vascular route in an abdominal skin flap in nude mice. Osteosarcoma cells were fluorescently imaged in the epigastric cranialis vein in the abdominal skin flap by confocal microscopy. Collagen fibers were imaged in reflectance mode. At early stages of tumor embolus-formation, cancer cells adhered firmly to each other, diffusely expressing αv integrin-GFP. Two weeks after injection, collagen fiber scaffolds were visualized at the margins of tumor emboli or within them. Four weeks after injection, cancer cells invading from emboli were strongly expressing αv integrin-GFP, and were aligned along collagen fibers. The results suggest αv integrin and collagen fiber scaffolds are important for tumor embolus formation, which are potential seeds of metastasis. J. Cell. Biochem. 118: 26-30, 2017. © 2016 Wiley Periodicals, Inc.

Calculation of contraction patterns in rat skin flap model

abstractIntroduction: In this study rat abdominal skin flaps were observed daily to explain their contraction behavior and a mathematical formula has been developed.Methods: 24 male rats were used for the study. Abdominal skin flaps based on the inferior epigastric neurovascular bundles were raised. In the first group all flaps were sutured to their donor area without any extra physical or chemical interference. In the second groups steroid was applied under the flaps to change the contraction rate.Results: Contraction rate was significantly higher in necrotic tissues in both groups. A formula was used to correct for the contraction. The corrected results for the seventh day necrotic area percentage measurements were significantly higher than actual measurements. (p = 0.0001).Conclusions: By using the mathematical formula developed in this study, pre-contraction value of the experimental skin flaps can be achieved and the results can be interpreted more accurately.

The effect of hyperbaric oxygen preconditioning on the expression of ICAM-1, VCAM-1, NF-κB and flap survival rate during ischemia-reperfusion injury in rat abdominal skin flap

To evaluate the effect of hyperbaric oxygen preconditioning on the expression of intercellular adhesion molecule-1 (ICAM-1),vascular cell adhesion molecule-1 (VCAM-1),NF-κB and flap survival rate during Ischemia-Reperfusion Injury in Rat Abdominal Skin Flap. 18 male adult SD rats were divided randomly into sham group (SH),ischemia-reperfusion group (IR) and hyperbaric oxygen preconditioning group (HBO),6 rats in each group. The rats in HBO group received regular hyperbaric oxygen treatment for three days (twice a day with an interval of 12 h) before operation. An abdominal skin flap pedicled with superficial epigastric artery was established. Ischemia lasted for 3 hours in the IR group and HBO group.On the third postoperative day,samples were taken to evaluate the expression of ICAM-1,VCAM-1 and NF-κB by immunohistochemistry staining and Western Blot. In the IR group, the flap survival rate and average blood perfusion were (22.38 ±4.35) ％ and (32.61 ±5.68) PU, while in the HBO group they were (45.34 ±3.15) ％ and (61.78 ±3.61) PU, showing significant difference between the two groups (P ＜0.01).The inflammatory cell infiltration condition in IR group was much higher than that in the HBO group from the HE staining observation. Compared with the HBO group,ICAM-1,VCAM-1 and NF-κB showed (+ + +) with higher positive cells in the IR group (P ＜ 0.01). Results of Western Blot showed similar conclusion. The relative expression of ICAM-1,VCAM-1 and NF-κB was much higher in the IR group than that in the HBO group (P ＜ 0.01). Hyperbaric oxygen preconditioning could decrease the expression of ICAM-1,VCAM-1,NF-κB and promote flap survival rate during the process of ischemia-reperfusion injury on a rat abdominal skin flap model.

The Divine Proportion "Ace of Spades" Umbilicoplasty: A New Method of Navel Positioning and Plasty in Abdominoplasty.

Achievement of a well-balanced positioned navel along the longitudinal axis with a pleasing shape and hidden scarring will have a tremendous impact on the overall cosmetic outcome of an abdominoplasty. In this era of navel display, piercing, and tattooing, an increasing attention is paid by people toward navel shape and position. However, in plastic surgery, there is no standardization regarding navel repositioning and plasty during abdominoplasty. The aim of this article is to describe the clinical translation of our observational study on navel surface anatomy by reporting our experience with a new umbilicoplasty technique. Between July 2013 and March 2014, 23 consecutive patients underwent elective deep inferior epigastric perforator free flap breast reconstruction. Patients' mean age was 45.5 years (range, 36-68 years). Ten patients were normal weight, 11 were overweight, and 2 were class-1 obese. All 23 patients underwent the divine proportion ace of spade umbilicoplasty. Pleasant looking, depressed, and oval navels with superior hooding were successfully achieved. No infection or necrosis of the navel skin or abdominal skin flaps was experienced. Additionally, no scar constriction, navel distortion, or stenosis occurred. Postoperative results were graded as excellent in 8 cases (36%), very good in 12 (55%), and good in the 2 cases (9%) with mildly hypertrophic scars. Patient satisfaction was high to very high. A Fibonacci caliper might aid in the proper positioning of the umbilicus on the abdominal wall avoiding an undesirable high- or low-riding navel. The "ace of spades" umbilicoplasty restores a natural-looking depressed navel with an oval shape and superior hooding.

The Average Size and Position of the Umbilicus in Young Men and Women.

Abdominoplasty was the third most common cosmetic surgical procedure in 2012. The umbilicus is transposed within the abdominal skin flap during this procedure. Few studies address the size and location of the umbilicus with precise measurements as well as those that do report on a heterogeneous population. The goal of our study was to determine the average size and position of the ideal umbilicus by limiting the study to young men and women of normal body habitus. Subjects were recruited in a University of Virginia Institutional Review Board-approved study. Demographics of the subjects were recorded. Each subject's umbilicus was assessed for height, width, and position relative to existing landmarks. Eighty subjects met the inclusion criteria: 43 women and 37 men. Most of the subjects were white (72.5%). The mean ± SD BMI was 22.4 ± 2.5 kg/m. The mean ± SD height and width of the umbilicus was 2.1 ± 0.6 cm and 2.3 ± 0.7 cm, respectively. The umbilicus was located at a mean ± SD of -0.7 ± 1.3 cm in relation to the iliac crest (crest at zero). There were differences seen in the position between men and women. There were no statistical differences in measurements between the races. Our study serves as a guide for umbilical positioning with mean measurements for men and women, and categorized by sex and race.

The Effect of Epigallocatechin Gallate on Flap Viability of Rat Perforator Abdominal Flaps.

Background Epigallocatechin gallate (EGCG) is a substance abundant in green tea. In this study, the effects of EGCG on perforator flap viability were investigated. Methods A total of 40 rats were assigned to four groups of 10 each. In each subject, a 4 × 6 cm abdominal skin flap was raised and adapted back onto its place. In the control group, no further procedures were taken. In the flap group, 40 mg/kg/d EGCG was injected into the flap. In the gavage group, 100 mg/kg/d EGCG was given through a feeding tube. In the intraperitoneal group, 50 mg/kg/d EGCG was injected intraperitoneally. On the 7th postoperative day, flaps were photographed and the viable areas were measured and compared via a one-way analysis of variance. Results The ratios of viable and contracted flap area were 9.15/12.01, 4.59/16.46, 11.56/11.20, and 11.65/10.77 cm(2) for the control, flap group, gavage group, and intraperitoneal group, respectively. While the flap group yielded the worst results in the sense of flap contraction and viability (p < 0.001), the gavage and intraperitoneal groups were significantly better than those of the control group (p = 0.03). Histologically, epidermal, papillary dermal, and capillary tissue volumes were evaluated. In comparison to the control group, the flap group yielded significantly increased epidermal and dermal volumes (p = 0.03), however, these values were significantly decreased (p = 0.04) in the gavage and intraperitoneal groups. Capillary volumes were significantly decreased in EGCG treatment groups (p < 0.01). Conclusion Our experiment has shown that oral and intraperitoneal administration of EGCG increases the perforator flap viability when compared with controls, while direct injection decreases the viability.

Intervention effects of systemic rehabilitation training on postoperative disuse shoulder dysfunction after abdominal pedicled skin flap transplantation

Objective To evaluate the intervention effects of systemic rehabilitation training on postoperative disuse shoulder dysfunction in hand injury patients received abdominal pedicled skin flap transplantation. Methods The 92 patients received same operation of abdominal pedicled skin flap surgery for unilateral hand in Hand and Foot Surgery Department of Provincial Hospital Affiliated to Shandong University and were divided into two groups, in which 45 patients as control group from March to April 2014 and 47 patients as experimental group from June to July 2014. The patients of control group received conventional therapy and nursing, while the ones of experimental group received systematic rehabilitation training by nurses and doctors before, during and after operation. Shoulder function was scored at the day 1 and day 7 after the pedicle division operation according to the shoulder joint function assessment scale, and we employed SPSS 20.0 to analyze the results. Results The shoulder function scores of experimental group patients were (72.96±4.72) and (87.91±4.74) at the day 1 and day 7 after the pedicle division operation, which were better than the scores of control group patients, [(65.11±6.74) and (79.38±7.31)] (t=6.492, 6.677; P<0.01). Conclusions The systemic rehabilitation training program, which requirements were definite, and guidance was standard and easy to perform, can significantly improve the shoulder function of the patients received abdominal pedicled skin flap transplantation. Key words: Hand injury; Rehabilitation training; Pedicled skin flap; Disuse shoulder dysfunction

Bladder exstrophy-epispadias complex with adenocarcinoma in an adult patient: A case report.

The present case report presents the case of exstrophy-epispadias complex (EEC) with the widest separation of the symphysis pubis to date. A 33-year-old male was referred to hospital with previously unreconstructed EEC malformation. The diagnosis established was of EEC with separation of the symphysis pubis and left inguinal hernia with adenocarcinoma of the bladder. The patient underwent radical cystectomy plus an ileal conduit and an expanded local lymphadenectomy. Osteotomy was not performed, and instead the defect of the pelvis and abdominal wall was repaired using meshes and a lower abdominal island skin flap. At 1 year after surgery the patient recovered well, with no indications of mesh distortion or major complications.

Effects of hyperbaric oxygen preconditioning on interlukin-23 level in rats after skin flap transplantation

Objective To explore the effects of hyperbaric oxygen preconditioning on ischemia-reperfusion inflammatory reaction of rats after skin flap transplantation. Methods Fifty-six Sprague-Dawley rats were randomly divided into 3 groups: a sham ischemia-reperfusion (SH) group, an ischemia-reperfusion (IR) group and a hyperbaric oxygen reconditioning (HBO) group. Both IR group and HBO group were further divided into 3 subgroups, respectively, according to the time points of serum sampling for test post establishment of the IR model of the abdominal pedicle skin flap transplantation. The IR model of the abdominal pedicle skin flap transplantation was established in all the animals except those in the SH group, with those in the HBO group were preconditioned with HBO twice daily for 3 days before the operation. The blood was sampled at 1, 3 and 5 day post-operation to test the level of IL-23 using enzyme-linked immunosorbent assay (ELISA). The survival skin flaps were sampled from all the animals at 3 and 5 days after the operation for histological observation and evaluation. Results The average IL-23 level of HBO 3 d subgroup (17.80±14.78) was significantly lower than that of the IR 3 d subgroup (38.91±12.26). The average histological scores of the IR 3 d and 5 d subgroups, as well as HBO 3 d and 5 d subgroups were (2.66±0.44) and (3.2±0.53), (1.85±0.31) and (2.29±0.32), significantly higher than SH group (0.38±0.10). Moreover, the average histological score of the HBO 3 d and 5 d subgroups was significantly lower than IR 3 d and 5 d subgroups respectively. Conclusion Hyperbaric oxygen preconditioning can relieve the ischemia-reperfusion inflammatory reaction through reducing the serum level of IL-23 in rats after skin flap transplantation. Key words: Hyperbaric oxygen preconditioning; Skin flap; Interleukin-23

Methane-rich saline attenuates ischemia/reperfusion injury of abdominal skin flaps in rats via regulating apoptosis level.

BackgroundIn plastic surgery, skin damage induced by ischemia/reperfusion (I/R) is a multifactorial process that often occurs. Methane gas has been reported to be a new therapeutic gas for attenuating I/R injury. In this study, we assessed the effects of methane-rich saline (MRS) in regulating apoptosis on skin flap I/R injury.MethodsMale Sprague–Dawley rats, 6–8 weeks old, were divided randomly into three groups: one sham surgery group (SH) and two surgery groups. After undergoing 6 h of I/R management of an abdominal skin flap, surgery groups were treated with physiological saline (I/R-P) or methane-rich saline (I/R-M). On the 3rd postoperative day, a laser Doppler flowmeter was used to measure flap blood supply, and hematoxylin and eosin (H&E) staining was used to observe morphological changes. TdT-mediated dUTP-X nick end labeling (TUNEL) staining was also used to observe early apoptosis and is presented as the percentage of TUNEL-positive cells. Moreover, pASK-1, pJNK, Bcl-2 and Bax were detected by immunohistochemical technology. Caspase-3 activity was also measured to evaluate the effects of MRS.ResultsCompared to the I/R-P group, the flaps in the I/R-M group presented a larger survival area and better blood perfusion with less inflammatory infiltration and cell apoptosis, a higher expression of Bcl-2, a lower expression of pASK-1, pJNK and Bax, and a lower caspase-3 activity.ConclusionAccording to the results, MRS attenuated I/R injury by regulating apoptosis and has the potential to be applied as a new therapy for improving skin flap survival.

Treatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap.

BackgroundOur aim was to summarize the treatment of degloving injury involving multiple fingers using combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap.Patients and methodsEach degloved finger was debrided under microscopic guidance and embedded in the superficial layer of the abdominal fascia. The abdominal skin was sutured to the skin on the back and side of the hand to promote circumferential healing. After removal, the only remaining injured region was on the flexor surface, and this was repaired by multiple dorsal toe flaps, toe-web flaps, and dorsalis pedis flaps to provide blood vessels and sensory nerves. All fingers had proper flap thickness 3–6 months after surgery, and required only lateral Z-plasty modification with web deepening and widening to narrow the fingers and extend their relative length.ResultsWe completed flap-graft and finger narrowing for 25 fingers in eight patients. Abdominal skin flaps and dorsal toe flaps were grafted, and resulted in both firmness and softness, providing finger flexibility. The dorsal toe flap provided good blood circulation and sensory nerves, and was used to cover the finger-flexor surface to regain sensation and stability when holding objects. During the 1–8 years of follow-up, sensation on the finger-flexor side recovered to the S3–4 level, and patient satisfaction based on the Michigan Hand Outcomes Questionnaire was 4–5. Flap ulcers or bone/tendon necrosis were not observed.ConclusionTreatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap was effective and reliable.

Microsurgery in 46 cases with total hand degloving injury

To summarize the characteristics of total hand degloving injury and investigate the curative effect of microsurgery. A total of 46 patients with total hand degloving injury were enrolled in this study. The injury classification and treatment methods were as follows: Type I (11 cases), treated by replantation of the gloved skin; Type II (6 cases), treated by reconstruction using thumb wrap-around flap and second toe; Type III (4 cases), treated by reconstruction using bilateral second toe with dorsal foot flap; Type IV (9 cases), treated by replantation in situ or reconstruction; Type V (16 cases), treated by replantation or abdominal flap reconstruction. Of the patients who received Type I treatment, five completely survived, whereas eight had finger necrosis. In Type II, both the reconstructed fingers and hand flaps survived. For four patients who received Type III treatment, eight reconstructed fingers survived. In Type IV, two patients with reconstructed fingers survived, whereas the six with replantation in situ had necrosis of the partial palmar or hand dorsum skin. In Type V, nine patients with reconstructed fingers survived, and five cases with abdominal skin flap reconstruction and one case with anterolateral femoral flap survived. The restoration of hand appearance and function was the best in patients who received replantation. For reconstruction cases, however, the hand function was recovered to the basic self-care level. In cases with abdominal flap reconstruction, the hand function showed poor recovery. Total hand degloving injury can be classified into different types according to the injury degree. The appropriate microsurgical treatment based on these types can produce better curative effect.