Ju Jihui, Li Jianning, Hou Ruixing
Department of Orthopaedics, Ruihua Hospital Affiliated to Soochow University, Suzhou 215104, China.
Department of Orthopaedics, Ruihua Hospital Affiliated to Soochow University, Suzhou 215104, China.
Asian J Surg. 2015 Oct;38(4):205-9. doi: 10.1016/j.asjsur.2015.01.004. Epub 2015 Mar 14.
To summarize the characteristics of total hand degloving injury and investigate the curative effect of microsurgery.
A total of 46 patients with total hand degloving injury were enrolled in this study. The injury classification and treatment methods were as follows: Type I (11 cases), treated by replantation of the gloved skin; Type II (6 cases), treated by reconstruction using thumb wrap-around flap and second toe; Type III (4 cases), treated by reconstruction using bilateral second toe with dorsal foot flap; Type IV (9 cases), treated by replantation in situ or reconstruction; Type V (16 cases), treated by replantation or abdominal flap reconstruction.
Of the patients who received Type I treatment, five completely survived, whereas eight had finger necrosis. In Type II, both the reconstructed fingers and hand flaps survived. For four patients who received Type III treatment, eight reconstructed fingers survived. In Type IV, two patients with reconstructed fingers survived, whereas the six with replantation in situ had necrosis of the partial palmar or hand dorsum skin. In Type V, nine patients with reconstructed fingers survived, and five cases with abdominal skin flap reconstruction and one case with anterolateral femoral flap survived. The restoration of hand appearance and function was the best in patients who received replantation. For reconstruction cases, however, the hand function was recovered to the basic self-care level. In cases with abdominal flap reconstruction, the hand function showed poor recovery.
Total hand degloving injury can be classified into different types according to the injury degree. The appropriate microsurgical treatment based on these types can produce better curative effect.
总结全手脱套伤的特点并探讨显微外科治疗效果。
本研究共纳入46例全手脱套伤患者。损伤分类及治疗方法如下：Ⅰ型（11例），采用带手套皮肤再植治疗；Ⅱ型（6例），采用拇指套状皮瓣和第二趾再造治疗；Ⅲ型（4例），采用双侧第二趾加足背皮瓣再造治疗；Ⅳ型（9例），采用原位再植或再造治疗；Ⅴ型（16例），采用再植或腹部皮瓣再造治疗。
Ⅰ型治疗患者中，5例完全存活，8例手指坏死。Ⅱ型中，再造手指和手部皮瓣均存活。Ⅲ型治疗的4例患者中，8个再造手指存活。Ⅳ型中，2例再造手指患者存活，6例原位再植患者出现部分手掌或手背皮肤坏死。Ⅴ型中，9例再造手指患者存活，5例腹部皮瓣再造患者和1例股前外侧皮瓣患者存活。接受再植的患者手部外观和功能恢复最佳。然而，对于再造病例，手部功能恢复至基本自理水平。腹部皮瓣再造病例中，手部功能恢复较差。
全手脱套伤可根据损伤程度分为不同类型。基于这些类型进行适当的显微外科治疗可产生更好的疗效。
