gms | German Medical Science

Objectives/Interrogation: Treatment of multiple finger degloving injuries is one of the most difficult problems in hand surgery. Although many methods of reconstruction that preserve function and reduce deformities have been described, none provide a satisfactory solution to this problem. The purpose of this report was to explore the results of treatment of degloving injuries of multiple fingers using modified random abdominal flaps.

Methods: From 2009 to 2016, five patients with hand degloving injuries were treated using modified random abdominal flaps. Based on Yamada's technique [1], the flap was designed over the abdomen with the fingers separated and marked on the abdominal skin.The skin was incised transversely at the basal border, which initiated the growing process of the finger flap. The dissection was done on superficial fat above Scarpa's fascia and a pocket was created for each finger separately (taking utmost care not to tunnel into the undersurface and into Scarpa's fascia). This created a tunnel in the superficial fascia layer into which each finger was inserted separately (Figure 1).

Results and Conclusions: All the flaps survived. Wound unhealing occurred in one finger in case One and in case Five. All the wounds healed well after full-thickness skin grafts were used. The modified method required 1-2 operations and the duration of time was 2.5-3.5 months (Average, 3.1 months). All the patients were followed for more than 8 months. The appearance of the repaired fingers in modified group was not bulky without defatting. All the fingers were shorter than the normal fingers without finger nails. The thumb could be opposed to all of the fingers except the small one. The repaired hand gained grip and write function, and could be used for daily life activities (Figure 2). Unfortunately, the sensation of the repaired finger was poor and was graded as S3.