MANAGEMENT OF DEGLOVING INJURIES OF THE HAND USING ABDOMINAL FLAPS- A RELIABLE AND DURABLE RECONSTRUCTIVE OPTION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 9
Abstract
BACKGROUND Degloving injuries of the hand are quite common due to industrial injuries and road traffic accidents. In most of the cases, only the skin and subcutaneous tissue is avulsed leaving behind intact tendons and vessels. Early debridement and immediate flap cover are vital to prevent infection and to restore proper hand function. Delayed intervention and skin grafting over the exposed tendons result in compromised function of the hand. We describe abdominal flap as a durable option to cover these degloved hands. The aim of this study was to evaluate the effectiveness of abdominal flap as a reconstructive option to manage the avulsion injury of hand due to industrial injuries and road traffic accidents. MATERIALS AND METHODS The present study includes case series of 30 degloving injury of hand treated by abdominal flaps, in the Department of Plastic Surgery and Orthopaedics at Father Muller Medical College and Hospital, Mangalore between August 2015 and January 2017. Patient demographic data, medical histories, comorbidities, defect characteristics, hospitalization, complications and follow-up were evaluated and presented as uncontrolled case series. Exclusion criteria included patients with vascular injury, Peripheral vascular disease and uncontrolled diabetes. RESULTS The ages of the subjects were ranging from 8 to 38 years with an average of 20.8 years. The procedure was performed in two stages- thorough debridement and inset of the flap to the defect, followed by division of the flap after 3 weeks. The average duration of surgery was 80 minutes [range 60 -120 mins]. The defect in the abdomen after flap elevation was closed primarily with the help of undermining and tension sutures. A closed suction drain was kept after primary closure for 5 days to avoid seroma collection. Adhesive plaster strips were used to tie shoulder, arm and forearm to the patient’s trunk, so as to avoid shearing of flap from hand defect. All the abdominal flaps were healthy. Patients were discharged after 3-5 days and advised to get dressing once in 3 days. Flap was divided after 3 weeks and final inset of the flap to the defect was done. Physiotherapy was started immediately and continued for a period of 2 months. All the patients showed marked improvement in hand function and could return back to their work. The operated patients were followed up for 6 months. CONCLUSION Abdominal flap is one of best tools in reconstructing degloving injury of the hand. It gives a durable cover to the exposed tendons and facilitates early mobilisation and preservation of hand function.
Authors and Affiliations
Arvind Lakshmana Rao, Jabez Gnany
Keywords
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- EP ID EP411180
- DOI 10.14260/jemds/2018/249
- Views 88
- Downloads 0
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