Clinical Observation Of Different Treatment Methods For Degloving Injury Of Hand Skin

Objective: Hand skin degloving injury is a common and serious hand injury in clinic.It means that the hand skin is torn off from the hand like a "glove".Due to the defects of skin and soft tissue and the exposure of deep tissues such as bones,tendons,blood vessels and nerves,it is very difficult to repair effectively in the early stage.During treatment,it is necessary to repair the skin defects of the back of the palm and fingers,At the same time,the shape,feeling and function of the hand should be restored.There are great differences in the efficacy of repair methods.How to treat hand degloving injury in order to retain the original function and appearance to the greatest extent has always been a difficult problem for hand surgeons.Due to the different levels of hand degloving and extensive soft tissue injury,there are many surgical schemes for the repair of hand degloving injury.This study hopes to summarize the two surgical schemes of free tissue transplantation and abdominal pedicled flap repair through the review of previous cases,including the general data of patients,surgical safety,postoperative function,appearance and surgical difficulty,It provides a basis for the selection of treatment scheme for whole hand skin degloving injury.Methods : The clinical data of 102 patients with total hand degloving injury diagnosed and treated in the hand surgery of Navy 971(former 401)hospital from June2011 to December 2021 were analyzed retrospectively.According to the different surgical methods,the patients were divided into group A and group B: group A had 50 patients with abdominal pedicled skin flap and group B had 52 patients with free tissue flap transplantation,The general conditions,operation time of flap repair,tissue survival rate,follow-up appearance and hand function,total treatment cycle,total length of hospital stay,operation times,donor site injury,doctor-patient satisfaction rate and re selection rate of operation scheme were summarized and compared between the two groups.Results:1.In the follow-up data of this study,we found that the injury age of patients has an impact on the selection rate of postoperative surgical scheme.Patients are divided into young,middle-aged and elderly according to their age,and the selection rate of surgical scheme is counted.Young and middle-aged patients have a higher selection rate for free tissue transplantation,while elderly patients have a higher selection rate for skin flap transplantation with abdominal pedicle.2.The flaps of the two groups survived100% after operation,and the difference was not statistically significant(P > 0.05).See Table 2 for details;The satisfaction rate of 86% in group A(free tissue group)was lower than 88.5% in group B(abdominal pedicled flap group)(P > 0.05).3.The excellent and good rate of hand function in the last follow-up between the two groups was 90% in group A(free tissue group),which was higher than 82.7% in group B(abdominal pedicled flap group)(P > 0.05).4.The average operation time of group A(free tissue group)was13.7 hours,which was 2.8 hours longer than that of group B(abdominal pedicled flap group)(P < 0.05);The average total hospital stay in group A(free tissue group)was 15.3days,which was less than 43.6 days in group B(abdominal pedicled flap group)(P < 0.05);The average total number of hospitalizations in group A(free tissue group)was 3.2,which was less than 7.5 in group B(abdominal pedicled flap group)(P < 0.05);The average total treatment period of group A(free tissue group)was 123.7 days,which was shorter than that of group B(abdominal pedicled flap group)503.4 days(P < 0.05).Conclusions:For the treatment of hand degloving injury,a comprehensive and systematic treatment plan should be formulated after the comprehensive evaluation of the patient’s injury,basic situation and the doctor’s technical level: 1.The total hospital stay and total treatment cycle of group A(free tissue group)are shorter than those of group B(abdominal pedicled flap group),and the number of free tissue transplantation is less than that of abdominal pedicled flap,The repair time of free tissue transplantation is longer than that of abdominal pedicled skin flap,and free tissue transplantation is less than that of abdominal pedicled skin flap.There is no significant difference in the excellent rate of hand function and the satisfaction rate of doctors and patients with appearance after the two surgical schemes are cured.Free tissue transplantation can be selected first than abdominal pedicled skin flap,but free tissue transplantation has high requirements for doctors’ surgical technology and patients’ basic vital signs.2.Young and middle-aged patients have a higher check rate for free tissue transplantation,while elderly patients have a higher check rate for skin flap transplantation with abdominal pedicle,but the complications such as upper limb joint stiffness after abdominal pedicle flap operation are higher;There is no significant difference in tissue survival rate between free tissue transplantation and abdominal pedicled flap,but free tissue transplantation requires higher microsurgical technology.Doctors with higher microsurgical technology can give priority to free tissue transplantation for young and middle-aged patients.