Twin digital and in-step neurovascularised free flaps for reconstruction of the degloved mutilated hands.
BACKGROUND
Degloved mutilated hand injury results in severe contracture of palmar surfaces after avulsion defects of soft tissue and insensate scarring of amputated digits at the proximal interphalangeal level. In an effort to restore the basic function of such hands, we simultaneously used a sensate in-step free flap for re-surfacing the first web space and sensate twin digital free flaps for re-surfacing the palmar defects of the thumb and index finger.


METHODS
Three male patients sustained degloved mutilated hand injury from a machine in a factory. The average age of the patients was 26 years. These injuries were reconstructed by concomitant twin digital neurovascularised free flaps harvested on the contralateral hands and the in-step neurovascularised free flaps harvested on the feet. The lateral plantar vascular pedicle of the in-step flaps was anastomosed to the vascular pedicle of the twin digital flaps by a flow-through fashion.


RESULTS
All flaps survived. These flaps provided durable sensate coverage and improved pinch and grasp. The morbidity of donor fingers and feet was minimal.


CONCLUSIONS
These described flaps supply durable glabrous sensate skin of prehensile function in degloved mutilated hands. Our method is useful in the reconstruction of degloved mutilated hands with amputated stumps of the thumb and counter digit more than 3 cm in length required for pinch and grip.
Oh
S J
SJ
Department of Plastic & Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeungandong Donangu Anyangsi Gyeonggido, 431-796, Republic of Korea. sjoh46@hotmail.com
Koh
S H
SH
Chung
C H
CH
D000062:Accidents, Occupational; D000328:Adult; D000673:Amputation, Traumatic / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D005383:Finger Injuries / Q000503:physiopathology / Q000601:surgery*; D005385:Fingers / Q000098:blood supply / Q000294:innervation / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D055815:Young Adult