A CASE OF DEGLOVING INJURY OF HAND RECONSTRUCTED BY A COMBINATION OF AN ANTEROLATERAL THIGH FLAP AND A GROIN FLAP

Quoc Lu Nguyen1,, Duy Khuong Le1
1 Thong Nhat Dong Nai Hospital

Main Article Content

Abstract

Background: Degloving injury of the hand is a rare but formidable challenge for surgeons. When replantation is not possible, we rely on distant pedicled flaps. We reported a case with degloving injury of hand were treated by using groin flap combined with pedicle anterolateral thigh (ALT) flap to sandwich to reconstruct injuried hand. After many surgeries, the patient can perform basic hand functions even though many surgeries are required. Objectives: To evaluate the results of treatment of degloving injury of hand by combination pedicled anterolateral thigh and groin flaps to sandwich. Materials and method: Case study. A patient had total degloving injury of hand was treated by using groin flap combined with pedicle anterolateral thigh (ALT) flap to sandwich. Results: Most of anterolateral thigh flap was necrotic at 6 weeks postoperatively, whereas groin flap survived after division at 6 weeks. Conclusion: In cases replatation is not possible, a combination of the ALT flap and the inguinal flap needs to be discreet.

Article Details

References

1. Tajima T. Treatment of open crushing type of industrial injuries of the hand and forearm: degloving, open circumferential, heat-press, and nail-bed injuries. The Journal of Trauma. 1974. 14(12), 995-1011, doi:10.1097/00005373-197412000-000022.
2. Kim K.S., Kim E.S., Kim D.Y., Lee S.Y., Cho B.H. Resurfacing of a totally degloved hand using thin perforator-based cutaneous free flaps. Ann Plast Surg. Jan 2003. 50(1), 77-81, doi:10.1097/00000637-200301000-00013.
3. Watson A.C., McGregor J.C. The simultaneous use of a groin flap and a tensor fasciae latae myocutaneous flap to provide tissue cover for a completely degloved hand. British Journal of Plastic Surgery. 1981. 34(3), 349-352, doi:10.1016/0007-1226(81)90029-1.
4. Sukop A., Tvrdek M., Duskova´ M., Padera J. Degloving injury—the use of a combination of free fasciocutaneous sensitive flap and pedicle flaps for reconstruction. Acta Chirurgiae Plasticae. 2005. 47(4), 107-111, doi:10.1016/S0072-968X(79)80013-3.
5. Senda H., Muro H., Terada S., Okamoto H. A case of degloving injury of the whole hand reconstructed by a combination of distant flaps comprising an anterolateral thigh flap and a groin flap. Journal of Reconstructive Microsurgery. 2011. 27(5), 299-302, doi:10.1055/s-00311278708.
6. Zelken J.A., Chang N.J., Wei F.C., Lin C.H. The combined ALT-groin flap for the mutilated and degloved hand. International Journal of the Care of the Injured. 2015. 46(8), 1591-1596, doi:10.1016/j.injury.2015.05.022.
7. Tuncer S., Findikçioğlu K., Ayhan S. Upper extremity reconstruction with pedicled anterolateral thigh perforator flap: a simple modification for a difficult situation. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2008. 61(9), 1119-1121, doi:10.1016/j.bjps.2007.11.071
8. Khan M.S., Kairinos N., Cadier M. The use of laser Doppler in determining timing for division of cross leg free flaps. British Journal of Plastic Surgery. 2005. 58(1), 120-121, doi:10.1016/j.bjps.2004.06.027.
9. Jones M.E., Withey S., Grover R., Smith P.J. The use of the photoplethysmograph to monitor the training of a cross-leg free flap prior to division. British Journal of Plastic Surgery. 2000. 53(6), 532-534, doi:10.1054/bjps.2000.3359.