Replantation of Degloved Skin of the Hand

Abstract

The treatment of a degloving injury is one of the most difficult problems in hand surgery. Various reconstructive procedures have been adopted in the past years, all with poor results. Between 1988 and 1995, nine patients with degloving injuries of the hand and fingers were treated by microsurgical replantation. The injury involved the thumb in three patients, the ring finger in three patients, the little finger in one patient, and multiple fingers in two patients. Successful complete revascularization was obtained in seven patients. In one case a superficial necrosis of the replanted thumb skin occurred with good preservation of the subcutaneous layer. In one patient with a degloving injury involving multiple fingers, revascularization was achieved only in the middle finger, and the first ray was secondarily resurfaced by a free flap from the foot. In our experience revascularization of the degloved skin does represent the best solution and must be managed as an emergency procedure. Coverage obtained in this way offers the best cosmetic result and allows early mobilization with good recovery of joint movement. Reestablishing sensibility is more difficult. It is not always possible to suture the nerves damaged by the trauma, and even when a careful primary nerve anastomosis is performed, the results often are unsatisfactory, probably because of the avulsive mechanism of nerve injury.

Promising long-term outcomes of the reused skin-graft technique for chronic gluteal hidradenitis suppurativa

“…The concept of replantation of the intact part of the affected skin-the -reused‖ or -recycled‖ skin graft technique-was adopted from the autografting of avulsed skin in degloving injury 23,24 . The degloved skin itself can be used as donor tissue for the skin defect generated by degloving injury even if soft tissue is severely damaged.…”

Degloving Injury

“…According to Adani et al, wound coverage after a complete degloving injury of the hand and fingers is one of the most difficult problems in hand surgery. Important structures such as tendons, nerves, and bones are exposed and will become necrotic, if not covered adequately [6,26,34,35]. The main problem in degloving injuries is the extensive damage to long segments of vessels which makes direct suture of the structures difficult.…”

Letter Regarding “Microsurgical Arterialization of Degloving Injuries of the Upper Limb”

“…4,5 In cases with complete degloving injuries, the degloved skin must be placed inside out and meticulously assessed for vessels suitable for anastomoses. 3,4 Although this is often technically demanding, it is worthwhile to find any arteries (0.5-1.0 mm in diameter) in the degloved tissue. The development of supermicrosurgery has made this type of anastomosis possible, and surgeons should take advantage of it.…”