A long-term follow-up was carried to evaluate the function of recipient site and the mobility of donor site after a combined five-free-tissue procedure for reconstruction of the complete degloved hand.
From 1995 to 2012, we performed a combined five-free-tissue procedure to reconstruct the complete degloved hand in one stage. Nine patients were included in this article. The five tissues included a great toe wrap-around flap for thumb, bilateral second toes for index and middle finger and bilateral anterolateral thigh (ALT) flaps for dorsal and palmar soft tissue defect. Subjective and objective evaluations were performed after 3years at least. Subjective evaluation included the DASH score, Michigan hand outcomes questionnaire and Maryland foot rating score. Objective measurements included pinch and grip strength, first web space distance, range of motion of reconstructed digitals, and two points discrimination of reconstructed thumb and fingers. The function of reconstructed thumb and fingers were evaluated according to the standard formulated by Chinese Hand Society of The Hand.
A reconstructed middle finger was necrosis after operation, while others were all survived. Seven patients were followed up from 3 to 12years (average 5.8years). The average DASH score was 21.6±16.58. Michigan hand function scores were as follows: hand function score was 67.5%±24.05%, activity of daily living score was 99.69%±32.58%, working score was 49.57%±25.45%, pain evaluation was 24%±21.38%, aesthetic score was 48.2%±7.11%, satisfaction rate was 78.4%±12.65%. Maryland foot rating average score was 84.56±2.44. The average range of motion (ROM) of metacarpal (MP) joint of reconstructed thumb was 56°±20.77°, index finger was 78°±10.33°, middle finger was 76°±9°. There was no active ROM at IP joint of each finger. The average grip power of involved side was 46.7% of uninvolved side. The pinch strength of the thumb and index finger of involved side was 66.52% of uninvolved side. The pinch strength of thumb and middle finger of the involved side was 61.3% of uninvolved side. Two-point discrimination (2-PD) of the pulp of thumb was 8.47±0.68mm, the pulp of finger was 10.59±0.82mm. There were pigmentary and hyperplasia scars in 2 cases. There was no complaint of pain after long-distance walking or long-time standing.
We conclude that the combined five-free-tissue transfer can promise satisfactory appearance and function for complete degloved hand.
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Publié par Elsevier Masson SAS.