Degloving injuries of the hand and fingers

Wound coverage after a complete degloving injury of the hand and fingers is 1 of the most difficult problems in hand surgery. Important structures such as tendons, nerves, and bones are exposed and will necrose if not covered adequately. The goal of treatment should be coverage with a pliable, sensitive, and cosmetically similar tissue that will allow early mobilization. The authors' experience has led them to adopt the following general guidelines: replantation of the avulsed structures whenever possible; early transfer of a free composite flap from the foot for a complete and irreparable degloving injury of the thumb; and selection of the radial forearm flap for multiple finger lesions. Between 1981 and 1993, 13 patients were treated for degloving injuries of the hand and fingers. Revascularization of the avulsed structures was possible in only 4 patients. In 6 patients with degloving injuries of the thumb in whom replantation was not possible, the thumb was reconstructed using a free wraparound flap from the big toe. In 3 patients with degloving injuries of the fingers, coverage was obtained as an emergency measure using an island radial forearm flap. In conclusion, replantation should be attempted when the degloved skin is available and the vessels are not damaged; secondary reconstruction should be done as early as possible to limit the time of tendon, bone, and joint exposure.