The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction

BackgroundTo explore the clinical effect of digital dorsal fascial island flap combined with crossfinger flap to repair distal degloving injury and sensory reconstruction.MethodsA total of 19 patients with distal fingertip degloving injuries treated with digital dorsal fascial island flap combined with crossfinger flap in our hospital from April 2018 to August 2020 were retrospectively included. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the fingers, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were evaluated.ResultsFive cases with post-operative flap blisters were treated at the time of dressing changes until successful scab formation. Three cases with post-operative arterial crisis of finger arterial dorsal branch vessel were relieved after suture removal and tension reduction. All other skin flaps and skin grafts survived. Nineteen patients received follow-up between 3 and 26 months (average 14.6 months). The active ROM of metacarpophalangeal (MCP) and interphalangeal (IP) joints of the injured fingers were satisfactory.ConclusionThe digital dorsal fascial island flap combined with the crossfinger flap for repairing the distal degloving injury of the distal segment of the finger is a good surgical method, which is simple and easy to operate, can repair a large area of soft tissue defect, and obtain a satisfactory effect.

Download Full-text

Repair of distal thumb degloving injury using combination of reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01940-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Ruizheng Hao ◽

Bin Wang ◽

Hui Wang ◽

Huanyou Yang ◽

Yongxin Huo

Keyword(s):

Middle Finger ◽

Island Flap ◽

Secondary Intention ◽

Degloving Injury ◽

Combined Use ◽

Active Range Of Motion ◽

Dorsal Branch ◽

Branch Vessel ◽

Degloving Injuries

Abstract Background To examine the efficacy of combination of the reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap for repair of distal thumb degloving injury. Methods Twelve patients with mechanical distal thumb degloving injuries were treated between February 2017 and August 2019. A combination of the reverse dorsoradial flap of the thumb and the middle finger proper digital arterial island flap were used. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the joints, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were sequentially evaluated. Results Two cases with postoperative flap blisters were treated at time of dressing changes up to successful scab formation. One case with postoperative arterial crisis of finger arterial dorsal branch vessel was successfully released in the pedicle. Ten cases healed by first intention and 2 cases by secondary intention. Twelve patients received follow-up examinations between 3 and 20 months (average 13 months) post-treatment, and all exhibited full, soft flaps with no fingertip pain. Conclusion The combined use of the reverse dorsoradial flap of the thumb and the middle finger proper digital arterial island flap is a practical and effective approach to surgical repair of distal thumb degloving injuries.

Download Full-text

Modified Heterodigital Neurovascular Island Flap for Sensory Reconstruction of Pulp or Volar Soft Tissue Defect of Digits

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2019.04.014 ◽

2020 ◽

Vol 45 (1) ◽

pp. 67.e1-67.e8 ◽

Cited By ~ 5

Author(s):

Hui Wang ◽

Xiaoxi Yang ◽

Chao Chen ◽

Yongxin Huo ◽

Bin Wang ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Defect ◽

Island Flap ◽

Tissue Defect ◽

Sensory Reconstruction

Download Full-text

Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415610529 ◽

2015 ◽

Vol 41 (2) ◽

pp. 177-184 ◽

Cited By ~ 15

Author(s):

H. Wang ◽

C. Chen ◽

J. Li ◽

X. Yang ◽

H. Zhang ◽

...

Keyword(s):

Island Flap ◽

Control Group ◽

Terminal Branch ◽

Level Of Evidence ◽

Mean Values ◽

Dorsal Branch ◽

Dorsal Metacarpal Artery ◽

Sensory Reconstruction ◽

First Dorsal Metacarpal Artery

Restoration of tactile sensation after reconstruction of a thumb pulp defect is import for hand function. We describe our clinical experience using a modified first dorsal metacarpal artery island flap innervated by the radial dorsal branch of the proper digital nerve and the terminal branch of the superficial radial nerve in 20 consecutive cases. The results were compared with 25 patients treated by the conventional Foucher’s first dorsal metacarpal artery flap without nerve repair. At the final follow-up, flap sensation was assessed using static two-point discrimination and Semmes–Weinstein monofilament testing. All flaps survived uneventfully in both groups. At the final follow-up, the mean values for static two-point discrimination and Semmes–Weinstein monofilament testing in the study group were significantly different from the values in the control group. The modified first dorsal metacarpal artery island flap provides a reliable and simple option for sensory reconstruction of thumb pulp defects. Level of evidence: Therapeutic, level III

Download Full-text

Full circumference lower extremity degloving injury treated with hydrosurgical debridement and negative-pressure wound therapy with gauze wound filler for fixation of avulsed flap skin grafts

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa498 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Tae Nagama ◽

Natsuko Kakudo ◽

Atsuyuki Kuro ◽

Yujiro Ozaki ◽

Yasuko Shirasawa ◽

...

Keyword(s):

Lower Extremity ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Traumatic Injury ◽

Skin Grafts ◽

Wound Therapy ◽

Left Lower Extremity ◽

Degloving Injury ◽

Severe Traumatic Injury ◽

Degloving Injuries

Abstract Degloving, a skin and subcutis avulsion, is a severe traumatic injury sometimes caused by rolling wheels or machines. Although avulsed flaps are often readapted to its original site, most of these tissues become necrotic. Due to the extensive skin and soft tissue deficiency caused by necrosis, treatment becomes difficult. Skin grafts harvested from avulsed flaps may be used to treat degloving injuries, while negative pressure wound therapy (NPWT) is used to secure the grafts. Commonly used porous polyurethane foam wound fillers are difficult to set in circumferential extremity degloving injuries; gauze-based wound fillers are easier to use and cause less pain during dressing changes. We present a case of an extensive, full-circumference left lower-extremity degloving injury, treated using NPWT with gauze-based wound fillers for fixation of skin grafts harvested from avulsed flaps after hydrosurgical debridement. For complex wound geometries, gauze-based wound fillers can be easily applied for skin graft immobilization.

Download Full-text

Evaluation of moving and static two point discriminations of volar forearm skin before and after transfer as a sensate radial forearm island flap in reconstruction of degloving injury of the thumb

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2006.05.001 ◽

2007 ◽

Vol 60 (4) ◽

pp. 356-359 ◽

Cited By ~ 3

Author(s):

Mohammad Javad Fatemi ◽

Mohammad Jalilimanesh ◽

Mohammad Taghi Dini

Keyword(s):

Island Flap ◽

Degloving Injury ◽

Before And After ◽

Forearm Skin ◽

Radial Forearm ◽

Volar Forearm

Download Full-text

Clinical Effectiveness of Dorsal Branch Skin Flap of Proper Palmar Digital Artery with Distal Pedicle in Repairing of Fingertip Soft Tissue Defect: A 1-Year Prospective Study in a Chinese Tertiary Referral Teaching Hospital

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835521500272 ◽

2021 ◽

Author(s):

Regis Ernest Mendame Ehya ◽

Guy-Armel Bounda ◽

Weidong Xiao ◽

Aixi Yu ◽

Qibai Wen

Keyword(s):

Soft Tissue ◽

Prospective Study ◽

Teaching Hospital ◽

Skin Flap ◽

Clinical Effectiveness ◽

Soft Tissue Defect ◽

Digital Artery ◽

Tertiary Referral ◽

Tissue Defect ◽

Dorsal Branch

Download Full-text

Degloving injury to groin, scrotum and penis due to low-velocity handlebar injury

BMJ Case Reports ◽

10.1136/bcr-2019-231598 ◽

2019 ◽

Vol 12 (11) ◽

pp. e231598

Author(s):

Hannah Thompson ◽

Oliver Burdall ◽

Kokila Lakhoo

Keyword(s):

Unusual Case ◽

Corpus Cavernosa ◽

Tunica Vaginalis ◽

Low Velocity ◽

Left Groin ◽

Degloving Injury ◽

Potential Damage ◽

The Right ◽

Degloving Injuries ◽

Literature Result

Bicycles are a common cause of blunt abdominal trauma causing 5%–14% of injuries. However, impalement or shear injuries from low-velocity mechanism of injury are rare. We report a case of a 14-year-old boy presenting with an extensive left groin injury sustained while cycling one-handed along the pavement at walking pace. The laceration ran for 12–14 cm from the left groin across the pubis to the right and 10 cm inferiorly into the perineum. This inverted the left scrotum and partially degloved the penis. The corpus cavernosa and tunica vaginalis were exposed up to the level of the superficial inguinal ring. Literature on handlebar-impalement injuries is sparse and the majority of penile degloving injuries described in the literature result from alternative mechanisms. This unusual case demonstrates the potential forces involved, and potential damage resulting from handlebar injuries even at low velocity.

Download Full-text