Replantation or revascularization for the treatment of hand degloving injuries

Zhang, Guangliang; Ju, Jihui; Jin, Guangzhe; Tang, Linfeng; Fu, Yi; Hou, Ruixing

doi:10.1016/j.bjps.2016.09.003

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…Hand injuries represent the most frequent body part for workrelated injuries involving either crushing, fracture, or amputation, with a lifetime prevalence of injuries leading to hospitalization of 15-46% and annual prevalence of 5-30% [1,2]. Injury mechanisms such as crush or high-voltage electrical injury can have devastating consequences, and degloving injuries can be mutilating [3][4][5]. Preservation of life as well as reconstruction of injured anatomical structures are the main medical aims following injury [6,7].…”

Section: Introductionmentioning

confidence: 99%

Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis

Werner

Alawi

2020

Eur J Plast Surg

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Background Severe hand injuries significantly limit function and esthetics of the affected hand due to massive trauma in skeletal and soft tissues. Surgical reconstruction is often unsatisfactory, so bionic prostheses are a consideration. However, assessment of functional outcomes and quality of life after surgical reconstruction to guide clinical decisions immediately after injury and in the course of treatment remain difficult. Methods We conducted a prospective follow-up analysis of patients with severe hand injuries during 2016–2018. We retrospectively evaluated initial trauma severity and examined current functional status, quality of life, general function, and satisfaction in everyday situations of the hand. We also developed a novel Hand Bionic Score to guide clinical recommendation for selective amputation and bionic prosthesis supply. Results We examined 30 patients with a mean age of 53.8 years and mean initial severity of hand injury (iHISS) of 138.4. Measures indicated moderate quality of life limitations, moderate to severe limitation of overall hand function, and slight to moderate limitation of actual hand strength and function. Mean time to follow-up examination was 3.67 years. Using the measured outcomes, we developed a Hand Bionic Score that showed good ability to differentiate patients based on outcome markers. Appropriate cutoff scores for all measured outcome markers were used to determine Hand Bionic Score classifications to guide clinical recommendation for elective amputation and bionic prosthetic supply: < 10 points, bionic hand supply not recommended; 10–14, bionic supply should be considered; or > 14, bionic supply is recommended. Conclusions While iHISS can guide early clinical decisions following severe hand injury, our novel Hand Bionic Score provides orientation for clinical decision-making regarding elective amputation and bionic prosthesis supply later during the course of treatment. The score not only considers hand function but also psychological outcomes and quality of life, which are important considerations for patients with severe hand injuries. However, future randomized multicenter studies are needed to validate Hand Bionic Score before further clinical application. Level of evidence: Level III, risk/prognostic study.

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Section: Introductionmentioning

confidence: 99%

Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis

Werner

Alawi

2020

Eur J Plast Surg

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“…In addition, secondary surgery after revascularization and replantation in high-grade degloving injury is often required to improve functional results. 4,10 Secondary procedures could increase the time off from work and cost. Indeed, this case required flexor tenolysis and a tendon graft for extension contracture due to impairment of flexor tendon gliding and reconstruction of the extensor central slip, respectively.…”

Section: Discussionmentioning

confidence: 99%

Destructive Arthropathy of the Interphalangeal Joint Following Revascularization After Degloving Hand Injury: A Case Report

Hirakawa

Komura

Masuda

et al. 2021

Hand (New York, N,Y.)

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It is difficult to achieve satisfactory results in the treatment of advanced degloving injury, which is one of the most challenging injuries in hand surgery. In this report, we present a case of marked destructive arthropathy of the interphalangeal joint that developed following revascularization after degloving hand injury. A 37-year-old, right-handed female manual worker sustained a degloving injury of her fingers, including the dorsal hand. We performed revascularization and secondary surgery, which included tenolysis and a tendon graft, to obtain functional improvement. These 2 procedures provided significant improvement in the active range of motion of the respective fingers. However, the patient complained of postoperative pain in the proximal interphalangeal joint. X-ray revealed destructive changes in the interphalangeal joint, which advanced progressively. Destructive changes in the interphalangeal joint following advanced degloving injury should be recognized as a potential complication that could be a limitation of functional restoration. Follow-up X-ray examination is necessary, even in cases with no fracture of the phalanges at the time of injury. In the management of degloving injury, patients should be informed of the potential risk of destructive arthropathy, which could result in restricted motion with pain.

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“…Time to return to work 9,21,[26][27][28][29]37,39,[58][59][60] 6. Hand function 41,46,47,[59][60][61][63][64][65][66] 7. Work performance 46 Domain: quality of life 1.…”

Section: Occurrence Of Acral Lesions 20mentioning

confidence: 99%

“…Sensation 9,16,[19][20][21][23][24][25][26][27][28][29][30][31]37,39,41,46,47,53,57,60,61,63,68,70 2. Cold sensitivity 16,[18][19][20]24,27,37,39,41,65 3. Pain 17,19,24,31,41,43,45,47,61,64,68,70 4.…”

Section: Continuous Categoricalmentioning

confidence: 99%

Reporting Outcomes and Outcome Measures in Digital Replantation: A Systematic Review

Moltaji

Gallo

Wong

et al. 2020

Journal of Hand and Microsurgery

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Purpose There is a lack of consensus on what the critical outcomes in replantation are and how best to measure them. This review aims to identify all reported outcomes and respective outcome measures used in digital replantation. Materials and Methods Randomized controlled trials, cohort studies, and single-arm observational studies of adults undergoing replantation with at least one well-described outcome or outcome measure were identified. Primary outcomes were classified into six domains, and outcome measures were classified into eight domains. The clinimetric properties were identified and reported. A total of 56 observational studies met the inclusion criteria. Results In total, 29 continuous and 29 categorical outcomes were identified, and 87 scales and instruments were identified. The most frequently used outcomes were survival of replanted digit, sensation, and time in hospital. Outcomes and measures were most variable in domains of viability, quality of life, and motor function. Only eight measures used across these domains were validated and proven reliable. Conclusion Lack of consensus creates an obstacle to reporting, understanding, and comparing the effectiveness of various replantation strategies.

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Replantation or revascularization for the treatment of hand degloving injuries

Cited by 8 publications

References 24 publications

Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis

Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis

Destructive Arthropathy of the Interphalangeal Joint Following Revascularization After Degloving Hand Injury: A Case Report

Reporting Outcomes and Outcome Measures in Digital Replantation: A Systematic Review

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