Lo Steven, Lin Yu-Te, Lin Cheng-Hung, Wei Fu Chan
Canniesburn Plastic Surgery Unit, Glasgow, UK; Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan.
Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan.
Injury. 2013 Mar;44(3):331-5. doi: 10.1016/j.injury.2013.01.025. Epub 2013 Jan 24.
Difficulties in management of major degloving injuries of the upper limb are compounded by their relative rarity and a lack of clarity in decision-making regarding surgical treatment strategies. Management options include salvaging the degloved segment through revascularization techniques such as direct arterial anastamosis or arterio-venous (AV) shunting, and reconstructing the unsalvageable degloving injury with microsurgical or non-microsurgical techniques. This article focuses on the use of revascularization techniques as a means to salvaging a major degloved segment. We propose a new classification to aid decision-making in strategies to salvage the degloved skin. This is based on assessment of the degloved segment regarding its suitability for revascularization, the choice of revascularization technique, and its anatomical expendability. Major degloving injuries involving the palm but not the digits is a strong indication for AV shunting in isolation (Group 1). Major degloving injuries that include the digits as well require both AV shunting and digital artery revascularization (Group 2). Major deglovings involving the dorsum of hand or forearm are only relative indications for AV shunting and traditional management with flap reconstruction or skin grafting is equally appropriate. This new classification and its application are discussed in a number of case examples.
上肢严重脱套伤的管理难度因相对罕见以及手术治疗策略决策缺乏明确性而更加复杂。管理选项包括通过直接动脉吻合或动静脉（AV）分流等血管重建技术挽救脱套部分，以及用显微外科或非显微外科技术重建无法挽救的脱套伤。本文重点介绍使用血管重建技术作为挽救主要脱套部分的一种手段。我们提出一种新的分类方法，以帮助在挽救脱套皮肤的策略中进行决策。这基于对脱套部分在血管重建适用性、血管重建技术选择及其解剖可切除性方面的评估。涉及手掌但不包括手指的严重脱套伤是单独进行AV分流的强烈指征（第1组）。包括手指的严重脱套伤也需要AV分流和指动脉血管重建（第2组）。涉及手背或前臂的严重脱套只是AV分流的相对指征，采用皮瓣重建或植皮的传统管理同样合适。在一些病例示例中讨论了这种新分类及其应用。
