title: Treatment of traumatic degloving injuries of the fingers and hand: introducing the "compartmented abdominal flap".
abstract: BACKGROUND
  Degloving injury of the hand and fingers is one of the most severe and debilitating hand injuries and an operation of choice is yet to be found. In this study, we introduce a modified abdominal flap, the "compartmented abdominal flap," for coverage of degloving injuries of the fingers and hand. The flaps reported up to now are diverse, and 2 or even 3 flaps in 1 session have been used to cover the hand and fingers. Often, the flaps used have mismatching colors and the donor defect is huge when 2 large flaps are used in 1 setting. In this study, we present a 1-flap solution to treat degloving injuries of the hand and fingers.
  
  
  METHODS
  The compartmented abdominal flap was used in 6 patients with different hand and/or finger degloving injuries, which were covered by a 1-flap procedure. The single flap is designed in 2 layers: the flap that is an abdominal flap is elevated as usual and at the next stage of dissection, we create a separate compartment for each finger in the superficial fatty layer of the skin flap making pockets that encircle each finger separately. An external fixator device is placed to hold the fingers in their respective pockets. The flap is severed in 3 to 4 weeks time in a serial manner. The volar surface of the fingers, which is covered by fatty tissues by then, is skin grafted at a later date.
  
  
  RESULTS
  All the flaps survived and the contour of the hand and sensation was superior to the earlier flaps reported in the literature and in our earlier patients. The grasp and pinch function is better owing to the adherence of tissues to the volar surfaces of the fingers. The slippery feel of flaps over the volar surfaces of the fingers in handling objects is not felt or seen.
  
  
  CONCLUSIONS
  The "compartmented abdominal flap" is a modification of the routine abdominal flap for degloving injury of the hand and fingers. The flap is designed in 2 layers: 1 layer is to cover the dorsum of the hand and the other is created in the fatty layer in separate compartments for each finger. At a later date and after flap separation, the raw volar surface is left to granulate and is then covered by a split thickness skin graft.
authors.affiliation: Department of Surgery, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Nazerani
authors.forename: Mohammad Hosein Kalantar
authors.initials: MH
authors.lastname: Motamedi
authors.forename: Tara
authors.initials: T
authors.lastname: Nazerani
authors.forename: Bardia
authors.initials: B
authors.lastname: Bidarmaghz
mesh_terms: D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D016267:External Fixators; D058752:Free Tissue Flaps; D006085:Graft Survival; D006230:Hand Injuries / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult