title: Replantation or revascularization for the treatment of hand degloving injuries.
abstract: OBJECTIVE
  The purpose of this study was to explore effective strategies of replantation or revascularization for the treatment of hand degloving injuries.
  
  
  METHODS
  Ten patients who had received replantation or revascularization surgery for hand degloving injury between 2002 and 2014 were included for this study. The average age at the time of surgery was 34.5 years (range 18-49 years). There were nine left and one right hand replantations. The cause of injury was an industrial machine press in all of them. The skin was avulsed from the palm to the distal phalangeal level in five patients, to the middle phalangeal level in four patients, and avulsed from the wrist crease level completely in one patient. All the degloved flaps were revascularized.
  
  
  RESULTS
  Both the degloved flap and phalanges survived completely in one patient, and partial survival of the flap occurred in the remaining patients. The patients were followed up from 15 months to 78 months (average, 38.1 months). Sensory recovery of the finger pulp ranged from S2 to S3+. Michigan Hand outcome Questionnaire (MHQ) score ranged from 29 to 96 with an average of 69.5.
  
  
  CONCLUSIONS
  Midlateral incision to reduce the secondary damage to the capillaries, repair of more vessels for circulation, application of full-thickness skin grafts to enlarge the survival area, and use of anticoagulation protocols during and postsurgery may be beneficial to improve the replantation survival of the degloved skin.
authors.affiliation: Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, No. 5 Tayun Road, Suzhou, Jiangsu 215104, China.
authors.forename: Guangliang
authors.initials: G
authors.lastname: Zhang
authors.affiliation: Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, No. 5 Tayun Road, Suzhou, Jiangsu 215104, China.
authors.forename: Jihui
authors.initials: J
authors.lastname: Ju
authors.affiliation: Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, No. 5 Tayun Road, Suzhou, Jiangsu 215104, China.
authors.forename: Guangzhe
authors.initials: G
authors.lastname: Jin
authors.affiliation: Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, No. 5 Tayun Road, Suzhou, Jiangsu 215104, China.
authors.forename: Linfeng
authors.initials: L
authors.lastname: Tang
authors.affiliation: School of Biology & Basic Medical Sciences, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu 215123, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Hand Surgery, Ruihua Affiliated Hospital of Soochow University, No. 5 Tayun Road, Suzhou, Jiangsu 215104, China. Electronic address: huarui1000@163.com.
authors.forename: Ruixing
authors.initials: R
authors.lastname: Hou
mesh_terms: D000328:Adult; D002681:China; D000069836:Degloving Injuries / Q000601:surgery*; D005260:Female; D005385:Fingers / Q000098:blood supply / Q000601:surgery; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012092:Replantation / Q000009:adverse effects / Q000379:methods; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods; D014022:Tissue Survival; D016896:Treatment Outcome
keywords: Degloving injury; Hand injury; Replantation; Revascularization