Improved Abdominal Pocket Flap For The Clinical Efficacy Of The Whole Glove Like Avulsion

Objective: degloving injury of the whole hand is a complex clinicaltrauma, injured often roll machine injured hand, squeeze and stretch the roleof soft tissue including skin, subcutaneous tissue, blood vessels, with nerveeven phalanx degloving. There are several ways to repair such damageclinically, but the effect of inaccuracies, is still a thorny problem of handsurgery. We have designed a modified abdominal "L" shaped pocket flaps torepair degloving injury of the whole hand, to investigate the effect of themodified "L"-shaped pocket flaps for treatment of hand degloving injury ofthe abdomen, which is more reasonable for clinical effective treatment for thewhole hand skin degloving injury to provide a theoretical basis and methods.Methods: The surgical treatment in our hospital for degloving injury ofthe whole hand in March2010to March2011avulsion of the20patients,including12males,8females, aged from17to50years old, all with varyingdegrees of fractures and deep tissue damage. We did10cases of traditionalabdominal pocket flap treatments and10cases of improved abdominal"L"-shaped pocket flap treatments. Followed up on thefollowing informationinto the group of objects: skin flap survival, flap appearance and efficiency ofthe total patients, hand activity and the rate of patient satisfaction. Weaccessed the injured hand function based on those criteria.Traditional abdominal skin flap pocket group: patients were supine limbabduction, and then we cut deep fascia along the normal skin outside thewound, followed by removing necrotic skin, subcutaneous tissue, necrosis ofmuscle tissue and clear organization of the pollution stop the bleedingcompletely and fully. Solution of hydrogen peroxide, benzalkonium and salinerepeatedly wash the wound to stop bleeding. According to the dorsal skindefect size, design the abdominal skin flap debridement. As a flap in the ipsilateral midclavicular line and umbilical horizontal line at the intersection atvertical injured hand placed in the direction "-" shaped incision, flapseparation sufficient subcutaneous tissue of the injured hand buried in thepocket flap. Four weeks after surgery, their own design of a flap in the thumband the outside of the first metacarpal and hand injuries of the ulnar tangent,do delay the flap after granulation tissue. In the next two weeks, when theblood circulation of the hand or fingers wound capillary regeneration can beaccepted at the original port and the pedicle skin graft skin incision. Theinjured hand was removed together with the flap with a closed or partially inthe abdomen skin graft to cover the wound and hurt the back of flap coverage,and hurt the palm of your hand side of the line thighs take free skin graftbandaged. One week after the removal of yarn package, active and passiveactivities of the metacarpophalangeal joint, the interval of8-12weeksinstallment line points refers to surgery.Surgical abdomen "L"-shaped pocket flap group: this is an improvedsurgical approach. After debridement is completed, reserve section1.5-2forfinger2-5. For each finger use kirschner wires in the extension position,measuring the back of the hand side of the skin without bleeding defect size inthe ipsilateral midclavicular line and umbilical horizontal line at theintersection as a flap cut at vertical injured hand placed in the direction"L"-shaped incision along the incision line of the design, cut the skin surface,the surface of the deep fascia along the "L"-incision set off a flap,intraoperative attention to a full stop bleeding. trim, from the free edge of theflap to the pedicle, was a "ladder" pruning, spring scissors to removesubdermal fat particles, retain the subdermal capillary network, that is,keeping the fat thickness of about2-3mm, the injured hand into the flap willhurt the wrist palm side of the wound edge and abdomen continuous suture,and then the flap wound margin and the abdominal wall and injured hand wassutured, the formation of a capacity of hand "pocket". Postoperative drainage,bandaging, fixation. Postoperative use of antibiotics to prevent infection,dressing. After three weeks of multi-line pedicle surgery, suture the abdominal wound dressing, the palm side of the granulation tissue coverage, line freeskin grafting yarn package bandaged eradication of the wound. Refers topatients with a control group.Results: The abdominal "L"-shaped pocket flaps to repair full-handdegloving injury10cases, the flap survived completely. Patients werefollowed up for l~1.5years, abdomen "L"-shaped pocket flap is better thanthe traditional abdominal pocket flap in texture, appearance and recovery ofjoint function. Exposed nerve with ultra-thin flap is readily accessible. Theflap of protective sensation can have earlier recovery. At the same time lessprone to late contracture. Total efficiency and patient satisfaction rates arehigher than the control treatment of the experimental group. The fingeractivity is better than the control group. The differences of the two groupswere statistically significant (P <0.05).Conclusion:1The improved abdominal L-shaped pocket flaps is easy to design, withoutanatomical vascular simple and safe operation.2The improved abdominal L-shaped pocket flaps has anatomical basis forthe distribution of abdominal blood and flap design features, improvedabdominal pocket flap with double pedicle blood supply to the flap bloodsupply is more abundant. This procedure is safer and easy-to-primary hospitalpromotion.3The abdomen for the District area, emergency one to eliminate the wound,reduce patient pain. limit for the District shelter, does not affect theappearance, and pedicle technique to close the abdominal wound or planting alittle free skin to eliminate wound.4The flap texture, flexibility and appearance of the patients easily, no needto repair thin and bare nerve of the subdermal vascular network. The skin flapis easy to establish feeling, restore some of the protective sensation. There isno need for improved abdominal pocket flap to do to delay pedicle technique.It is good for the early exercise to promote functional recovery of injuredhand. This technique is easier to promote clinically.