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Replantation of Degloved Skin of the Hand

Adani, Roberto M.D.; Busa, Riccardo M.D.; Castagnetti, Claudio M.D.; Castagnini, Luca M.D.; Caroli, Alessandro M.D.

Plastic and Reconstructive Surgery: May 1998 - Volume 101 - Issue 6 - p 1544–1551
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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. (Plast. Reconstr. Surg. 101: 1544, 1998.)

Modena, Italy

Roberto Adani, M.D. Sezione di Chirugia della Mano Policlinico, Largo del Pozzo 71 41100 Modena, Italy

From the Hand Surgery Unit, University of Modena. Received for publication March 4, 1997; revised July 8, 1997.

Presented at the Autumn Meeting of the British Society for Surgery of the Hand, November 6—8, 1996, in Birmingham, United Kingdom.

©1998American Society of Plastic Surgeons