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[Classification and treatment of whole hand degloving injury]
Jihui Ju1, Jianning Li, Haiwen Wang
1Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215104, P.R. China.
Insights
This study classifies whole hand degloving injuries into five types to guide treatment. Appropriate classification and surgical intervention, including replantation and flap reconstruction, improve functional outcomes and sensory recovery.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Plastic Surgery
Context:
- Whole hand degloving injuries are severe traumatic events.
- Effective classification and treatment are crucial for functional restoration.
Purpose:
- To classify whole hand degloving injuries.
- To explore treatment strategies based on injury classification.
- To evaluate functional outcomes after different treatments.
Summary:
- A classification system for whole hand degloving injuries (Types I-V) was developed.
- Treatment varied by type, including replantation, thumb/toe flaps, and abdominal flaps.
- Outcomes showed best function with replantation, followed by flap reconstructions, and least satisfactory with abdominal flaps.
Impact:
- This classification aids in selecting appropriate clinical treatment plans for hand degloving injuries.
- The findings guide surgeons in optimizing surgical strategies for better hand function restoration.
- Improved understanding can lead to better patient outcomes and quality of life.
Objective:
To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment.
Methods:
Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causes of injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm x 6 cm and 17 cm x 11 cm and the dorsal donor site was covered with free skin grafting.
Results:
After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps.
Conclusion:
Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the clinical treatment plan. The appropriate treatment based on these
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