Reconstruction of Hand Degloving Injury with a Free Anterolateral Thigh Flap -A Case Report

使用前大腿外側自由皮瓣重建手部脫手套傷－案例報告

Rowena Sudario-Lumague ； 林燦勳(Tsan-Shiun Lin) ； 郭寶仁(Pao-Jen Kuo) ； 謝青華(Ching-Hua Hsieh)

《臺灣整形外科醫學會雜誌》 26卷4期 (2017/12) Pp. 418-425

摘要

Background: In spite of different approaches reported in the literature, the reconstruction of a hand degloving injury, which requires extensive skin and soft tissue coverage, still presents a significant challenge for plastic surgeons. Aims and objectives: To repair a degloved hand with a free anterolateral thigh (ALT) flap, with subsequent syndactyly release and a debulking procedure, and to evaluate long-term outcomes. Methods: Here, we present the case of a 22-year-old man who had sustained a degloving injury of the right hand during a road traffic accident. The detached skin segment of the hand was severely damaged and could not therefore be replanted. After initial debridement, we performed immediate reconstruction with a 30 × 10-cm free ALT flap to cover the injury site. In order to prevent further contracture, we also released the interphalangeal joints of the third to fifth digits by fixation with K-wires extending through the distal phalanx. The volar skin defect was then resurfaced with a full-thickness skin graft. Two subsequent operations were required for syndactyly release and flap debulking. Results: Free flap reconstruction was successful with no major complication. The patient was able to return to his original work one year following surgery. Upon follow-up at around three years post-injury, the patient had a functional hand which could grasp and grip objects without difficulty. Conclusion: Immediate free ALT flap reconstruction, with subsequent syndactyly release and debulking, was an effective choice of repair for a degloved hand.

關鍵字

hand degloving injury ； free anterolateral thigh flap ； pedicle flap

並列摘要

背　景：雖然文獻上已有許多重建手部脫手套傷之方法，要重建手部脫手套傷大片皮膚軟組織之缺損仍是對於整型外科醫師的重大挑戰。目標及主旨：使用前大腿外側自由皮瓣並合併後續之手指分割及皮瓣打薄手術來重建手部脫手套傷，並且報告長期追蹤之結果。方　法：一位二十二歲之男性病患於車禍中罹致右手脫手套傷。脫手套分離之皮膚因為過於嚴重之創傷而無法進行再植手術。經過初步清創後，我們使用一個三十公分乘十公分的前大腿外側自由皮瓣來重建傷口，在另一次之手術中使用鋼釘固定第三至第五指以避免指頭攣縮並使用全層植皮重建手掌剩餘之皮膚缺損。之後並執行兩次階段性之手指分割及皮瓣打薄手術。結　果：自由皮瓣手術成功地執行且無主要之併發症。病患一年後可以回到原來之工作崗位。在受傷後三年的追蹤時，病患可以回復到具備功能之手並可以無困難地抓握東西。結　論：立即性之前大腿外側自由皮瓣覆蓋，合併後續之手指分割及皮瓣打薄手術是對於重建手部脫手套傷之一種良好選擇。