The combined ALT–groin flap for the mutilated and degloved hand

Abstract Background Degloving and mutilation of the hand is a rare but formidable challenge. When replantation is not possible, we rely on distant pedicled flaps. We present a technique using pedicled anterolateral thigh (ALT) and groin flaps to sandwich and resurface the degloved hand. The purpose...

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Bibliographic Details
Published in:Injury 2015-08, Vol.46 (8), p.1591-1596
Main Authors: Zelken, Jonathan A, Chang, Nai-jen, Wei, Fu-chan, Lin, Cheng-hung
Format: Article
Language:English
Subjects:
Adult
Anterolateral thigh flap
Degloving
Esthetics
Female
Groin
Hand Injuries - pathology
Hand Injuries - physiopathology
Hand Injuries - surgery
Hand reconstruction
Humans
Male
Mutilated hand
Orthopedics
Patient Satisfaction
Reconstructive Surgical Procedures - methods
Recovery of Function
Retrospective Studies
Skin Transplantation - methods
Surgical Flaps
Taiwan - epidemiology
Tendon Transfer - methods
Thigh
Toes - innervation
Toes - transplantation
Treatment Outcome
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Summary:Abstract Background Degloving and mutilation of the hand is a rare but formidable challenge. When replantation is not possible, we rely on distant pedicled flaps. We present a technique using pedicled anterolateral thigh (ALT) and groin flaps to sandwich and resurface the degloved hand. The purpose of this study is to describe the rationale, indications, methods and outcomes of combined pedicled ALT and groin flap reconstruction of the degloved hand. Methods Five injuries were treated at this center between 2011 and 2014. Charts were retrospectively reviewed and outcomes evaluated. Four ALT–groin flaps were performed in a single stage for degloving, crush and combined injuries. In one case, partial necrosis of a tight groin flap necessitated secondary ALT coverage at a second stage. Results Flaps survived after division at 4 weeks, and venous congestion was not observed at any point. Debulking, syndactyly release and toe transfer followed reconstruction to enhance outcomes. Conclusions The combined ALT–groin flap is safe and feasible for the reconstruction of the degloved or mutilated hand when replantation is not an option. It is attractive for familiar donor anatomy, donor-site morbidity and the quantity and composition of the tissue it provides.
ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2015.05.022