Update on Replantation of Degloved Skin of the Hand

The treatment of hand degloving injuries is a challenging problem in reconstructive surgery. A pure degloving injury is a rare condition. Tendons, bones, and joints maintain their integrity, and the degloved skin has no chance for survival without revascularization. The stripped cover may be replanted by microvascular repair. However, replantation is often difficult, particularly when multiple fingers are involved and skin, subcutaneous tissue, and vessels are severely damaged.

The authors reported their experience in the treatment of “pure” degloving injuries involving the hand and fingers by microsurgical replantation. Between 1988 and 2000, 12 patients were treated. Successful complete revascularization was obtained in 10 patients. All cases between 1988 and 2000 were reviewed, with a mean follow-up period of 83 months (ranging from 140 to 30 months). The series included eight male and four female patients. Their mean age was 25 years (range: 16–47 years). Long-erm follow-up revealed good aesthetic and functional results. The mean total active range of motion for thumb and fingers was thumb range, 100–140 degrees; finger range, 70–210 degrees. Concerning sensibility, they reported a slight improvement, especially in longer followed-up patients (S2PD varies now from 10 to 13 mm), and no patient complained of cold intolerance. Regained sensation was adequate for finger function, and a secondary nerve reconstruction was not necessary.

On the basis of this favourable outcome, the authors believe that when the basic requirements (experienced surgical team, strongly motivated patient) are met, replantation of the skin in a degloving injury of the hand should be considered as the first reconstructive choice.