The use of island and free flaps in crush avulsion and degloving hand injuries.

Reconstructive options for early microsurgical tissue and island flap transfer are discussed in 23 patients with extensive avulsion and degloving injuries of the hands and fingers. The patients were divided into three groups (1) degloving thumb injuries; (2) crush avulsions with or without degloving of the palm and fingers; (3) complete degloving injuries of the hand and distal forearm. There were 11 free and 12 island flap transfers. There was partial loss in two flaps with satisfactory esthetic and functional results in these patients. The advantages and indications for the use of distally based radial forearm flap for degloving thumb injuries and pedicled ulnar forearm flap for avulsion of the distal part of the hand are discussed. The use of free transfer of greater omentum in the cases of extensive degloving of the hand is shown.