A new classification to aid the selection of revascularization techniques in major degloving injuries of the upper limb.
Difficulties in management of major degloving injuries of the upper limb are compounded by their relative rarity and a lack of clarity in decision-making regarding surgical treatment strategies. Management options include salvaging the degloved segment through revascularization techniques such as direct arterial anastamosis or arterio-venous (AV) shunting, and reconstructing the unsalvageable degloving injury with microsurgical or non-microsurgical techniques. This article focuses on the use of revascularization techniques as a means to salvaging a major degloved segment. We propose a new classification to aid decision-making in strategies to salvage the degloved skin. This is based on assessment of the degloved segment regarding its suitability for revascularization, the choice of revascularization technique, and its anatomical expendability. Major degloving injuries involving the palm but not the digits is a strong indication for AV shunting in isolation (Group 1). Major degloving injuries that include the digits as well require both AV shunting and digital artery revascularization (Group 2). Major deglovings involving the dorsum of hand or forearm are only relative indications for AV shunting and traditional management with flap reconstruction or skin grafting is equally appropriate. This new classification and its application are discussed in a number of case examples.
Canniesburn Plastic Surgery Unit, Glasgow, UK; Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan.
Steven
S
Lo
Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan.
Yu-Te
YT
Lin
Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan.
Cheng-Hung
CH
Lin
Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taiwan. Electronic address: fcw2007@adm.cgmh.org.tw.
Fu Chan
FC
Wei
D000062:Accidents, Occupational / Q000706:statistics & numerical data; D000328:Adult; D001134:Arm Injuries / Q000503:physiopathology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D003661:Decision Support Techniques; D005383:Finger Injuries / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008866:Microsurgery; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D034941:Upper Extremity / Q000293:injuries; D014945:Wound Healing