Experimental Research And Clinical Application Of Microsurgery Treating Degloving Injury Of Skin

[Objectives]:To create the experimental model of extensive degloving injury and evaluate the influence of venous anastomoses and/or arteriovenous for the survival of skin with reversed avulsion injury. To study the consequence of degloving injury of upper extremities treated by venous anastomoses.[Method]:1。Animal experimental:The surgical procedure were carried out with the health Japanese white rabbits under general anaesthesia using Ketamine Hydrochloride. 3.3:1 distal-based avulsion skin was made of the back legs of experimental animal respectively. Each group included 10 rabbits. Group A:the avulsed skin was sutured back to the original size; Group B:two veins were anastomosised and then the avulsed skin was sutured back; Group C:the avulsed skin was cut longitudinally,two veins were anastomosised and then the avulsed skin was sutured back; Group D:the avulsed skin was cut longitudinally,two veins were anastomosised and the other vein was anantomosised with an aretery, then the avulsed skin was sutured back.Appearance of color, tension, degree of angioplerrosis, ecchymosis, swell and necrosis had been observed during the post-op period. The survival condition was evaluated based on survival area calculating in one month postoperation.Additional 2 rabbits of each group were prepared for pathological examination of one week postoperation.The Blood-gas analysis was carried out in group B,C and D.2.We treated 7 cases of degloving injury of hand and 3 cases of degloving injury of upper limb, and anatomosised 3-5 veins of degloving skin each case.[Result]:1。Group A:the degloving skin of one-month-postoperation was contracted 55.9% and 36.3% degloving skin was survived. Group B:the degloving skin of one-month-postoperation was contracted 30.9% and 51.3% degloving skin was survived. There were significant differences between the two groups(P<0.05).In study 50.5% degloving skin was survived in Group C and 60.2% degloving skin was survived in Group D.There were significant differences between the two groups(P<0.05).31.9% degloving skin was contracted in Group C and 26.9% degloving skin was contracted in Group D.There were not significant differences between the two groups(P>0.05).2.For the 7 cases of degloving injury of hand, all of the degloving skin is survival in 5 cases and a little necrosis in 2 cases. After follow-up of 3 months to 12 months, good aesthetic and functional results is achieved. The active function examination excellent 3 cases, good 3 cases and fair 1 case.The sensibility examination:4 cases of S4,1 case of S3+ and 2 cases of S2.For the 3 cases of degloving injury of upper limb, although there is a little necrosis, most of the degloving skin is survival.After follow-up of 1.5 month to 6 months, good aesthetic and functional results is achieved.[Conclusions]:1.The venous anatomoses may improve the survival of the degloing skin by reducing the venous congestion and ameliorating the blood supply of degloving skin.2.Although arteriovenous can augment the blood supply of degloving skin, as a non-physical blood-circulation, it also promotes blood congestion, tissue swollen and fibrosis in the degloving skin. So it would not be used to treat degloving injury until some advancement can be made.