Liu Hongjun, Guo Tao, Wang Bin, Wu Fan, Zhang Wenzhong, Xu Tao, Gu Jiaxiang, Lu Yiming
Department of Foot and Hand Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu Province, China.
The Yangzhou School of Clinical Medicine of Dalian Medical University, Dalian, Liaoning Province, China.
J Hand Microsurg. 2024 Aug 24;16(5):100151. doi: 10.1016/j.jham.2024.100151. eCollection 2024 Dec.
The completely degloving injury of multiple fingers is a challenging clinical problem. Based on our technical experience, a novel two-stage surgery of abdominal hypodermal pocket followed by separation and full thickness skin grafting was conducted.
From January 2017 to August 2020, 7 cases (17 fingers) of degloving injury of multiple whole fingers who were treated in a two-stage fashion; an emergency first stage surgery of abdominal hypodermal pocket embedding and a second stage surgery (4 weeks later) of full thickness skin grafting, were retrospectively studied. The results were evaluated according to the patient subjective evaluation, static two-point discrimination and disabilities of the arm, shoulder and hand (DASH) scores and active range of motion (ROM) of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints.
All seven cases healed successfully, although two cases experienced distal phalanx necrosis. The affected fingers recovered with a good appearance and soft texture and the results were either satisfying or acceptable for all participants. The active ROM of MP joint ranged from 55° to 64° with an average of 59.5° three months postoperatively and ranged from 70° to 81° with an average of 77.2° six months postoperatively, while the active ROM of PIP joint ranged from 58° to 69° with an average of 64.1° three months postoperatively and from 76° to 86° with an average of 81° six months postoperatively. One year postoperatively, the static two-point discrimination ranged from 7 to 10 mm with an average of 8.6 mm and DASH scores ranged from 25 to 42 with an average of 37.
A novel two-stage surgery of abdominal hypodermal separated pockets followed by full thickness is an effective and worthwhile option for treating the completely degloving injury of multiple fingers.
多指完全脱套伤是一个具有挑战性的临床问题。基于我们的技术经验，开展了一种新型的两阶段手术，即先进行腹部皮下袋状手术，然后进行分离和全厚皮片移植。
回顾性研究2017年1月至2020年8月期间采用两阶段方式治疗的7例（17指）全手指脱套伤患者；第一阶段为急诊腹部皮下袋状植入手术，第二阶段（4周后）为全厚皮片移植手术。根据患者主观评价、静态两点辨别觉、手臂、肩部和手部功能障碍（DASH）评分以及掌指（MP）和近端指间（PIP）关节的主动活动范围（ROM）对结果进行评估。
所有7例均成功愈合，尽管有2例出现末节指骨坏死。患指外观恢复良好，质地柔软，所有参与者对结果均满意或可接受。术后3个月，MP关节的主动ROM为55°至64°，平均为59.5°；术后6个月，ROM为70°至81°，平均为77.2°。而PIP关节术后3个月的主动ROM为58°至69°，平均为64.1°；术后6个月为76°至86°，平均为81°。术后1年，静态两点辨别觉为7至10mm，平均为8.6mm；DASH评分为25至42，平均为37。
一种新型的先进行腹部皮下分离袋状手术然后进行全厚皮片移植的两阶段手术是治疗多指完全脱套伤的一种有效且值得采用的方法。
