Salvage of degloved digits with heterodigital flaps and full thickness skin grafts.

The purpose of this paper is to report the salvage of degloved digits (class III ring avulsion injuries [Urbaniak et al classification] [J Hand Surg Am. 1981;6:25-30]) using the heterodigital neurovascular island flap (originally developed by Moberg and Littler) in addition to full thickness grafting.Six fingers with class III ring avulsion injuries (Urbaniak et al classification) were included. The volar surface is covered with a heterodigital island flap from the adjacent finger, while a full thickness graft is applied to the dorsum.All flaps survived. Mean graft take was 85%. Mean static two point discrimination was 8.3 mm. The mean total active range of motion in the digits with intact tendons was 190 degrees. In the digits with absent tendons the total active range of motion was 90 degrees. Cold intolerance and cross sensibility were reported in half of the patients. Mean follow-up was 20.3 months (range: 6-42 months).The technique described is useful to salvage degloved digits when replantation is not feasible and the patient refuses amputation despite careful counseling. Donor finger morbidity however is a major concern, and in this regard both patient and surgeon should consider the decision carefully.