Extensive Hand Degloving Injury Reconstructed by Wrap-around Flap and Toe-to-Finger Transfer: A Case Report

Abstract

  Extensive degloving injuries of the hand are usually treated with a groin flap. However, the reconstructed hand has no perception, and the outcome is not always cosmetically and functionally satisfactory. We report a case of extensive degloving injury of the hand, that was reconstructed with wrap-around flap and toe transfer. A 19-year-old male with severe obesity sustained an extensive degloving injury of his right hand caused by a confectionery roller. The skin beyond the wrist was almost completely degloved. Revascularization of the degloved skin was performed on the day of injury; however, the entire skin was necrotized. All digits were amputated at the base of the proximal phalanx and covered with a unilateral pedicled groin flap. Subsequently, the thumb was reconstructed using a wrap-around flap. This allowed side pinch. To better improve hand function and appearance, a toe transfer was performed to the index finger. Active flexion range of the index finger was improved by flexor tenolysis eight months after the toe transfer. A toe graft provides good perception and appearance with a nail plate; however, a reduction in the number of fingers and loss of the toes are inevitable.