title: One-stage debulking procedure after flap reconstruction for degloving injury of the hand.
abstract: OBJECTIVE
  The aim of this study is to evaluate the use of one-stage debulking procedure to separate the fingers after flap reconstruction for degloving injury of the hand.
  
  
  METHODS
  From January 2009 to June 2014, 15 patients with degloving injuries of the hand were treated at the Kaohsiung Chang Gung Memorial Hospital. Among the 15 patients, 11 sustained degloving injury of the fingers; free flap reconstruction was performed in three patients, and a pedicle flap was used in eight. Four patients sustained complete degloving injuries of the hand; reconstruction was performed with an anterolateral thigh pocketing procedure. One-stage debulking procedure was performed for debulking of the flap and interdigitation from the flap envelope.
  
  
  RESULTS
  After the 12-month follow-up and rehabilitation, the fingers could move independently and perform in opposition with the thumb. Protective sensation was also regained. The patients with degloving injury of the fingers could return to daily activity and work after 1-year follow-up, while those with complete degloving injury of the hand could return to daily activities and work after 18-month follow-up.
  
  
  CONCLUSIONS
  The use of ALT pocketing procedure is simple for salvage of complete degloving injury of the hand. One-stage debulking procedure provides thin and durable skin coverage for hand after reconstruction. The fingers can also be separated from the envelope of a bulky flap for independent movement to fulfill functional and aesthetic requirements.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: tslin51@yahoo.com.tw.
authors.forename: Tsan-Shiun
authors.initials: TS
authors.lastname: Lin
mesh_terms: D000328:Adult; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D003646:Debridement; D000069836:Degloving Injuries / Q000473:pathology / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000473:pathology / Q000601:surgery; D006230:Hand Injuries / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D020127:Recovery of Function; D012677:Sensation; D013524:Surgical Flaps / Q000601:surgery*; D055815:Young Adult
keywords: Anterolateral thigh pocketing procedure; Degloving injury; Flap reconstruction; One-stage debulking procedure