Hand and wrist complete degloving: A case report and litterature review

• Published in: Annales de chirurgie plastique et esthétique 2024-10
• Main Authors: Chouquet, L., Berkane, Y., Paleu, G., Gandolfi, S., Camuzard, O., Lupon, E.
• Format: Article
• Language: English
• Subjects: Couverture de la main; Degloving hand; Degloving injury; Dégantage; Groin flap; Hand skin defect; Lambeau inguinal; Matrice dermique artificielle; Perte de substance tissulaire de la main; Synthetic skin substitute
• ISSN: 0294-1260; 1768-319X; 1768-319X
• DOI: 10.1016/j.anplas.2024.09.005

Complete hand degloving injuries are traumatic avulsion injuries causing the skin to pull away from the underlying tissues and are most often caused by industrial machinery. We present the case of a degloving trauma of the whole fingers, hand, and wrist resulting in a “watch hand” by analogy with the “ring finger” and discuss alternatives and recommendations from the rare cases described of similar traumas. A 33-year-old manual worker, a non-smoker with no significant medical or surgical comorbidities, was admitted for a complete skin avulsion of the left hand and wrist following a work-related accident with a trommel-type industrial roller. Our approach covered the five fingers and the dorsal aspect of the hand and wrist with an artificial dermal matrix, while the palmar side of the hand and wrist was covered with a pedicled groin flap in emergency. At 15months, the patient's sensitivity was classified as S1 on the sensory evaluation scale, joint mobility was less than 30°, and the residual hand retained what we might call “basic” functions, i.e., a counterweight when carrying loads and the ability to pick up and hold a light object in the thumb-index grasp. Complete soft tissue hand defects are exceptional and require urgent treatment. If re-implantation is not possible, combining a dermal matrix with a pedicled flap is a simple salvage solution. The risks of vascular, infectious, and stiffening complications in these traumas are high and must be prevented. Patients must be warned of the severity of the trauma, the need for secondary surgeries to restore a policy-digital grip, and the poor functional results expected. Les lésions de dégantage complet de la main sont des lésions d’avulsion traumatique provoquant l’arrachement de la peau des tissus sous-jacents. Nous présentons le cas d’un dégantage de l’ensemble des doigts, de la main et du poignet et discutons des alternatives et des recommandations à partir des rares cas décrits de traumatismes similaires. Un travailleur manuel de 33 ans, non-fumeur, sans comorbidité médicale ou chirurgicale significative, a été admis pour un dégantage complet de la main et du poignet gauche suite à un accident de travail avec un rouleau industriel. Nous avons couvert les cinq doigts et la face dorsale de la main et du poignet avec une matrice dermique artificielle, tandis que la face palmaire de la main et du poignet a été couverte en urgence par un lambeau pédiculé inguinal. À 15 mois, la sensibilité du patient était