An outcome comparison for the treatment of totally degloved hand combining with multiple metacarpus and phalange fractures
LIU Yu-jie
DING Xiao-heng
QU Zhi-gang
SUN Le-tian
JIAO Hong-sheng
ZHANG Hong-xun
ZHONG Xiao-peng
JI Xiang
ZHENG Bo
Abstract：Objective To compare the outcome for the treatment of totally degloved hand combining with multiple metacarpus and phalange fractures by different means and to explore its classification and treatment. Methods From January 2005 to January 2014, 28 cases were collected. Degloved skin could not be back implanted in all cases, accompanied by bone and joint injuries. Standardized assessment of outcomes was based on static two-point discrimination ( s2PD ), grip power of the reconstructed hand, time taken to return to work, and active total range of motion of the operated finger ( ROM ). Results ( 1 ) Patients were divided into 4 types mainly according to fractures. Type I: not severe injury of hand and joint, main fingers could be reconstructed to a certain length with functions. Type II: fingers 2-5 could not be reconstructed to a certain length with functions, the thumb could be reconstructed. Type III:fingers 2-5 could be reconstructed to a certain length with functions, the thumb could not be reconstructed. Type IV: all 1-5 fingers could not be reconstructed to a certain length with functions. ( 2 ) Options of the treatment: 12 cases were of type I, in which 5 cases were repaired by traditional abdomen pocket flap and 7 cases were repaired by toe transfer with a dorsalis pedis skin flap combined with abdominal S-shaped tile-joint subdermal vascular network flaps. Six cases were of type II, in which 3 cases were repaired by different types of abdominal flaps and toe transfer at stage II. Another 3 cases were repaired by wraparound flaps of toe and abdominal flap at the stage I. Five cases were of type III and IV. All patients were repaired by abdominal flap and the thumb was reconstructed by toe transfer at stage II. All flaps and skin grafts survived. All patients were followed up from 12 to 24 months ( mean: 16 months ). Compared with toe transfer at stage II, transfer at stage I showed a better recovery. Conclusions Finger amputation should be chosen cautiously and treatment should be considered according to classifications. Applications of abdominal flap and toe transfer at early stage can acquire satisfactory functional recovery.
Keywords：Hand jointsSurgical flapsAmputationHand injuriesFinger injuriesWounds and injuriesMicrosurgery
Publication Date：2015-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 941-945 )