Effects of thinned anterolateral thigh perforator flaps combined with finger splitting and webplasty in sequential treatment of degloving destructive wound of total hand

Yin Shanqing; Zhu Feng; Huang Yaopeng; Pan Jiadong; Xiao Dongchao; Liu Linhai; Li Xueyuan; Wang Xin

doi:10.3760/cma.j.cn501225-20240723-00275

Volume 40 Issue 11

Nov. 2024

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(11): 1052-1058

Yin SQ,Zhu F,Huang YP,et al.Effects of thinned anterolateral thigh perforator flaps combined with finger splitting and webplasty in sequential treatment of degloving destructive wound of total hand[J].Chin J Burns Wounds,2024,40(11):1052-1058.DOI: 10.3760/cma.j.cn501225-20240723-00275.

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Effects of thinned anterolateral thigh perforator flaps combined with finger splitting and webplasty in sequential treatment of degloving destructive wound of total hand

doi: 10.3760/cma.j.cn501225-20240723-00275

Department of Hand Surgery, Ningbo No.6 Hospital, Ningbo315000, China

Funds:

Ningbo Top Medical and Health Research Program 2022020506

Municipal Key Research and Development Program of Ningbo 2022Z146

Ningbo Science and Technology Plan Project 2018A610258

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Corresponding author: Wang Xin, Email: Dr.wangxin@qq.com
Received Date: 2024-07-23

Abstract

Abstract

Objective To investigate the effects of thinned anterolateral thigh perforator flaps combined with finger splitting and webplasty in sequential treatment of degloving destructive wound of total hand. Methods This study was a retrospective observational study. From January 2012 to January 2023, a total of 15 cases who met the inclusion criteria with degloving destructive wound of total hand were admitted to Ningbo No.6 Hospital, including 10 males and 5 females, aged 17-75 years. The wounds were all combined with exposed bones or tendon. Emergency debridement and vacuum sealing drainage were performed in all cases before flap transplantation in stage Ⅰ. After thorough debridement, the wound area was 11.0 cm×3.0 cm-23.0 cm×13.5 cm. One or both anterolateral thigh perforator flaps with size of 12.5 cm×5.0 cm-25.0 cm×15.5 cm were designed, cut, and thinned to repair the skin and soft tissue defects of the hand. The donor site was sutured directly or repaired with medium-thickness skin graft from the opposite thigh. As needed, the flap was reconstructed by finger splitting and webplasty once or more times every 3 months after stage Ⅰoperation. The survival and complications of flap and wound healing at the donor site were observed after stage Ⅰoperation. The appearance of flap, two-point discrimination distance, and hand function were observed during the follow-up. At the final follow-up, the function of the affected hand was evaluated by the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association. Results After the operation of stage Ⅰ, all the flaps of 15 cases of patients survived completely, including 1 case that had arterial crisis of flap but survived completely after exploration and re-anastomosis of blood vessels; all the wounds at the donor site healed. During the follow-up period of 6 to 18 months after stage Ⅰ, the flap was slightly swollen, with a little pigmentation, and the two-point discrimination distance in the finger flap was 8-11 mm. The fingers could complete the basic life actions such as flexion, extension, pinch, and grip. At the final follow-up, 3 cases were excellent, 9 cases were good, and 3 cases were acceptable in function evaluation of the affected hand. Conclusions For degloving destructive wound of total hand, free transplantation of one or both thinned anterolateral thigh perforator flaps is used for repair in stage Ⅰ, and finger splitting and webplasty are used to reconstruct the flaps in the later stage, which can basically restore the pinch and grip function of the affected hand that is required for daily life, and is worthy of clinical promotion.
- Hand,
- Degloving injuries,
- Surgical flaps,
- Microsurgery,
- Wound repair

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References

[1]	LinM, ZuoX, HeF, et al. Clinical application of an expanded reverse-island flap with two dorsal metacarpal arteries and dorsal metacarpal nerves in index- and middle-finger-degloving injury repair and amputation reconstruction[J]. J Plast Reconstr Aesthet Surg, 2023,77:309-318. DOI: 10.1016/j.bjps.2022.10.057.
[2]	KimKS, KimES, KimDY, et al. Resurfacing of a totally degloved hand using thin perforator-based cutaneous free flaps[J]. Ann Plast Surg, 2003,50(1):77-81. DOI: 10.1097/00000637-200301000-00013.
[3]	YamadaN, UiK, UchinumaE. The use of a thin abdominal flap in degloving finger injuries[J]. Br J Plast Surg, 2001,54(5):434-438. DOI: 10.1054/bjps.2001.3611.
[4]	丁健, 杨景全, 吴志鹏, 等. 手部脱套伤的分型和术式选择[J].中华显微外科杂志,2015,38(6):557-560. DOI: 10.3760/cma.j.issn.1001-2036.2015.06.010.
[5]	潘达德, 顾玉东, 侍德.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志, 2000, 16(3):130-135. DOI: 10.3760/cma.j.issn.1005-054X.2000.03.003.
[6]	KrishnamoorthyR, KarthikeyanG. Degloving injuries of the hand[J]. Indian J Plast Surg, 2011,44(2):227-236. DOI: 10.4103/0970-0358.85344.
[7]	Orozco-GradosJJ, CordovaJC, Garcia GarciaJA, et al. Groin flap for reconstruction of traumatic degloving hand injury: a report of 5 cases[J]. World J Plast Surg, 2023,12(1):63-71. DOI: 10.52547/wjps.12.1.63.
[8]	AfsharA, TabriziA, AidenlouA. A degloved hand was resurfaced with sandwich flaps[J]. World J Plast Surg, 2023,12(3):90-93. DOI: 10.61186/wjps.12.3.90.
[9]	HayashiK, HattoriY, SakamotoS, et al. Reconstruction of total hand degloving injury with combined free and pedicled flaps and ilizarov minifixator[J]. Plast Reconstr Surg Glob Open, 2024,12(7):e5976. DOI: 10.1097/GOX.0000000000005976.
[10]	VenkatramaniH, SabapathySR, ZhangD. Revascularization of a circumferential hand and forearm degloving injury using an arteriovenous shunt[J]. J Hand Surg Am, 2021,46(7):629.e1-629.e6. DOI: 10.1016/j.jhsa.2020.08.005.
[11]	ArnezZM, KhanU, TylerMP. Classification of soft-tissue degloving in limb trauma[J]. J Plast Reconstr Aesthet Surg, 2010,63(11):1865-1869. DOI: 10.1016/j.bjps.2009.11.029.
[12]	NazeraniS, MotamediMH, NazeraniT, et al. Treatment of traumatic degloving injuries of the fingers and hand: introducing the "compartmented abdominal flap"[J]. Tech Hand Up Extrem Surg, 2011,15(3):151-155. DOI: 10.1097/BTH.0b013e3182051c02.
[13]	WooSH, KimJS, SeulJH. Immediate toe-to-hand transfer in acute hand injuries: overall results, compared with results for elective cases[J]. Plast Reconstr Surg, 2004,113(3):882-892.DOI: 10.1097/01.prs.0000105340.26227.b5.
[14]	LinYH, JengCH, HsiehCH, et al. Salvage of the skin envelope in complex incomplete avulsion injury of thumb with venous arterializaiton: a case report[J]. Microsurgery, 2010,30(6):469-471. DOI: 10.1002/micr.20790.
[15]	ŻylukA, SzlosserZ, PuchalskiP. The results of the treatment of hand - outcomes of the treatment of hand degloving injuries with greater omentum flaps[J]. Pol Przegl Chir, 2019,91(6):20-27. DOI: 10.5604/01.3001.0013.5495.
[16]	BajantriB, LatheefL, SabapathySR. Tips to orient pedicled groin flap for hand defects[J]. Tech Hand Up Extrem Surg, 2013,17(2):68-71. DOI: 10.1097/BTH.0b013e31827ddf47.
[17]	RasheedT, HillC, RiazM. Innovations in flap design: modified groin flap for closure of multiple finger defects[J]. Burns, 2000,26(2):186-189. DOI: 10.1016/s0305-4179(99)00114-x.
[18]	AbdelrahmanM, ZelkenJ, HuangRW, et al. Suprafascial dissection of the pedicled groin flap: a safe and practical approach to flap harvest[J]. Microsurgery, 2018, 38(5):458-465. DOI: 10.1002/micr.30238.
[19]	夏成德, 狄海萍, 邢培朋, 等. 游离股前外侧皮瓣修复烧伤后小腿环形大面积软组织缺损的临床效果[J].中华烧伤杂志,2019,35(4):248-252. DOI: 10.3760/cma.j.issn.1009-2587.2019.04.003.
[20]	周飞亚, 张弦, 蔡乐益, 等. 精准定位的微型股前外侧穿支皮瓣修复手指中等面积皮肤软组织缺损的效果[J].中华烧伤与创面修复杂志,2024,40(2):165-171. DOI: 10.3760/cma.j.cn501225-20231030-00150.
[21]	KoshimaI, NanbaY, TsutsuiT, et al. New anterolateral thigh perforator flap with a short pedicle for reconstruction of defects in the upper extremities[J]. Ann Plast Surg, 2003,51(1):30-36. DOI: 10.1097/01.SAP.0000058496.80058.12.
[22]	LeeJT, HsiaoHT, TungKY, et al. Successful one-stage resurfacing and contouring of an extensively burned cheek by using a scar template free anterolateral thigh flap: a case report and literature review[J]. J Trauma, 2008,65(1):E1-3. DOI: 10.1097/01.ta.0000235506.41681.6e.
[23]	何晓清, 杨曦, 石岩, 等. 精准皮瓣外科理念下逆行股前外侧皮瓣修复膝关节前方创面的临床效果[J]. 中华烧伤与创面修复杂志, 2023, 39(7): 648-654. DOI: 10.3760/cma.j.cn501225-20221020-00461.
[24]	徐达传, 钟世镇, 刘牧之,等.股前外侧部皮瓣的解剖学一个新的游离皮瓣供区[J]. 临床应用解剖学杂志,1984,2(3): 158-160. DOI: 10.13418/j.issn.1001-165x.1984.03.012.
[25]	LakhianiC, LeeMR, Saint-CyrM. Vascular anatomy of the anterolateral thigh flap: a systematic review[J]. Plast Reconstr Surg, 2012,130(6):1254-1268. DOI: 10.1097/PRS.0b013e31826d1662.
[26]	尹路, 宫可同, 徐建华, 等. 改良薄型股前外侧穿支皮瓣修复手足部软组织缺损[J].中华显微外科杂志,2018,41(5):417-420. DOI: 10.3760/cma.j.issn.1001-2036.2018.05.001.
[27]	狄海萍, 邢培朋, 郑军杰, 等. 超薄股前外侧皮瓣一期分指修复手掌合并多指创面的疗效[J].中华烧伤与创面修复杂志,2023,39(9):835-841. DOI: 10.3760/cma.j.cn501225-20221129-00514.
[28]	JuJH, HouRX. Repair of a degloving injury of the thumb with a combined dorsal great toenail flap and dorsalis pedis flap: a case report[J]. Arch Orthop Trauma Surg, 2013,133(10):1455-1458. DOI: 10.1007/s00402-013-1807-5.
[29]	HanF, WangG, LiG, et al. Treatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap[J]. Ther Clin Risk Manag, 2015,11:1081-1087. DOI: 10.2147/TCRM.S86948.
[30]	RuiY, MiJ, ShiH, et al. Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers[J]. Microsurgery, 2010,30(6):449-456. DOI: 10.1002/micr.20777.

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