The Feasibility Research Of Repairing The Whole Hand Degloving Injuries By Free Bilateral Pistol Anterolateral Femoral Flaps

Objective:To explore the feasibility of free bilateral pistol anterolateral femoral flaps for one stage in treating the whole hand degloving injuries.Methods:This research included model establishment, experiment of living body measurement, autopsy simulation repairing experiment and clinical application. The model establishment:the left hands were made to the models of the whole hand degloving injuries in two flesh cadaveric specimens, which made the distal wrist horizontal grain much skin for both sides of midlateral line of each thumb’s radial side and little finger’s ulnar side, and divided into palmar part and dorsal part on the surfaces of extensor and flexor tendons to form the model of the whole hand degloving injuries. On the basis of the following model, the repaired model, it only kept basic functional unit of the hand (the palmar and dorsal of hand, the whole thumb, and the middle finger of proximal and half of middle phalanx which refered to retention shallow flexor tendon check point). The wounds of which were divided into two parts:the palmar part and dorsal part, and repaired by bilateral anterolateral femoral flaps. In the experiment of Living body measurement,50 healthy adults (female,25 and male,25) without hand diseases were randomly selected, according to the repaired model, the length and width of the palmar and dorsal part of basic functional unit of the hand were measured; according to the literature and related professional teaching materials, taking the range of maximum length and width of anterolateral femoral flaps, and compared with each other for statistics. The autopsy simulation repairing experiment : on the basis of the repaired model, bilateral pistol anterolateral femoral flaps were designed and harvested from both the thighs according to the wound shape of the repaired model, and used to repair the repaired model of the whole hand degloving injuries, thus the repairing effects were observed. Clinical application:it emphases on the establish method and consideration of blood supply and sensory between the flaps and the repaired hand.Results:According to the experiment of living body measurement, it showed that the length of the palmar part of basic functional unit of the hand was 13.84±0.88cm, the width was 14.48±1.11cm, the length of the dorsal part was 12.15±1.09cm, the width was 14.92±1.11cm. According to the literature and related professional teaching materials on anterolateral femoral flap, the length of the flap was 30.59±6.21cm, the width was 16.33±3.27cm. As a result, it showed that the corresponding diameter size of anterolateral femoral flap was enough larger than that of skins of basic functional unit of the hand. According to the repaired model of the wound shape for designing bilateral pistol anterolateral femoral flaps to repair the model in the autopsy simulation repairing experiment, the appearance of the repaired hand was satisfactory. The results suggested that bilateral pistol anterolateral femoral flaps can be respectively provided to cover the wound surface of the repaired model of the whole hand degloving injuries.Conclusions:Using free bilateral pistol anterolateral femoral flaps for one stage the reconstruction of the whole hand degloving injuries is feasible. Both basic function and appearance of reconstructed hand were well.