Degloving combined with structural trauma at the digital level: functional coverage with fascial free flaps

Major trauma to the digit that includes skin degloving and tendon loss, as well as fractures, nerve segmental loss, and devascularization can render that digit chronically painful, stiff, insensate, and a detriment to the overall function of the hand to the point that such digits may be candidates for ray resection. Large wounds may exceed the ability to achieve coverage by regional pedicle flaps. When the wound is restricted to the level of the digit, the narrow cylindrical shape and the ability to flex and fold make an absolute requirement for a very thin, as well as supple, flap a requirement that cutaneous free flaps cannot meet. This series reports on 12 male patients with major degloving and structural trauma at the digit level in which bone, tendon, and nerve reconstructions were covered with free fascial flaps and immediate split-thickness skin grafts, followed by early rehabilitation. All patients achieved sufficient functional recovery so that subsequent surgeries were not indicated.