[Strategy for defect coverage in extensive degloving and crush injuries of 4 fingers]

Severe crush injuries with avulsion require specific treatment strategies. Usually we find complete loss of soft tissue, nerves and vessels, where only tendons and parts of the phalanges are preserved. Primary reconstructive procedures are usually not possible due to the complexity of the injury with severely destroyed structures. Bone shortening should be avoided in order to maintain finger length and motion. Therefore, emergency soft-tissue coverage represents the first step. Later, sensibility and mechanical stability of the skin should be restored. In our clinic, seven patients with this injury pattern were treated. Three cases involved four finger crush-avulsion injuries. In all cases, we performed a primary soft-tissue coverage with a pedicled flap. In a second session, the skin areas of the first web space of both feet were transplanted as neurovascular flaps. With this strategy, a useful hand function could be restored. The functional results are described and advantages and disadvantages of various techniques discussed.