A two-stage surgery for completely degloving injury of multiple fingers: A retrospective cohort study.

Abstract

Purpose: The completely degloving injury of multiple fingers is a challenging clinical problem. Based on our technical experience, a novel two-stage surgery of abdominal hypodermal pocket followed by separation and full thickness skin grafting was conducted.

Methods: From January 2017 to August 2020, 7 cases (17 fingers) of degloving injury of multiple whole fingers who were treated in a two-stage fashion; an emergency first stage surgery of abdominal hypodermal pocket embedding and a second stage surgery (4 weeks later) of full thickness skin grafting, were retrospectively studied. The results were evaluated according to the patient subjective evaluation, static two-point discrimination and disabilities of the arm, shoulder and hand (DASH) scores and active range of motion (ROM) of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints.

Results: All seven cases healed successfully, although two cases experienced distal phalanx necrosis. The affected fingers recovered with a good appearance and soft texture and the results were either satisfying or acceptable for all participants. The active ROM of MP joint ranged from 55° to 64° with an average of 59.5° three months postoperatively and ranged from 70° to 81° with an average of 77.2° six months postoperatively, while the active ROM of PIP joint ranged from 58° to 69° with an average of 64.1° three months postoperatively and from 76° to 86° with an average of 81° six months postoperatively. One year postoperatively, the static two-point discrimination ranged from 7 to 10 mm with an average of 8.6 mm and DASH scores ranged from 25 to 42 with an average of 37.

Conclusion: A novel two-stage surgery of abdominal hypodermal separated pockets followed by full thickness is an effective and worthwhile option for treating the completely degloving injury of multiple fingers.