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Free Fascial Mitten Hand Flaps

Vitali Azouz M.D. Michael Subichin M.D. Lawrence Cervino M.D.
Summa Health
2020-02-14

Presenter: Vitali Azouz

Affidavit:
I certify that the material represents the original work of the residents and has not been previous submitted elsewhere.

Director Name: Douglas Wagner

Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Hand

BACKGROUND:
Complex degloving injuries of the hand present unique challenges in reconstruction. Aggressive debridements can lead to amputations while delayed coverage can lead to desiccation and loss of function. Though many techniques have been described, the consensus on management remains controversial. We present a stepwise approach for treating these injuries.

METHODS:
We reviewed the four-decade experience of the senior author's reconstructive techniques for treating degloving injuries. This included immediate skin grafting for single digits and free fascial flaps for larger injuries that involved multiple digits and denuded vital structures. The free fascial mitten hand flap technique involves minimal debridement, urgent fascial only free flap with full thickness skin grafting, and subsequent sequential syndactyly release of the mitten hand.

RESULTS:
Patients who underwent free fascial mitten hand flaps began hand therapy and active range of motion at 5 days postoperatively. All patients went on to have syndactyl release within 6 months after injury. No patient required phalangeal amputation. At follow up, patients reported near full range of motion and functional use of their hand.

CONCLUSION:
Free fascial mitten hand flaps are an effective technique for treatment of complex degloving complex injuries of the hand and should be considered on initial presentation.

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