PMC10200088_01
Total traumatic avulsion of the fourth and fifth fingers, with preservation of the metacarpal bones and partial avulsion of 80% of the middle phalanx of the third finger
wjps-12-63-g001.jpg
PMC10200088_01_wjps-12-63-g001.jpg
F1
There was a loss of coverage on the palm and ulnar surface, and partial avulsion of the flexor digitorum profundus of the second finger (Fig 1).
Separation of the pedicled flap, resulting in good coverage of the skin defect and preservation of thumb opposition
wjps-12-63-g002.jpg
PMC10200088_01_wjps-12-63-g002.jpg
F2
After three weeks, during the second surgical procedure, the pedicle of the flap was separated, resulting in good coverage of the skin defect and preservation of thumb opposition, with the option for a future toe transfer (Fig 2).
PMC10200088_02
Total degloving of the second finger up to the base of the proximal phalanx, and total avulsion of the flexor digitorum profundus within the distal phalanx
wjps-12-63-g003.jpg
PMC10200088_02_wjps-12-63-g003.jpg
F3
Upon physical examination, he presented with total degloving of the second finger up to the base of the proximal phalanx, and total avulsion of the flexor digitorum profundus within the distal phalanx (Fig 3).
Groin flap tubular design to provide coverage of the entire surface of the second finger
wjps-12-63-g004.jpg
PMC10200088_02_wjps-12-63-g004.jpg
F4
The patient was taken to the operating room, and after surgical cleaning, a groin flap was designed to provide tubular coverage for the entire surface of the second finger (Fig 4).
PMC10200088_03
Total degloving injury of the thumb up to the proximal phalanx, with preservation of the insertion and function of all extensor and flexor tendons
wjps-12-63-g005.jpg
PMC10200088_03_wjps-12-63-g005.jpg
F5
Upon physical examination, the patient presented with total degloving of the thumb up to the proximal phalanx, with preservation of the insertion and function of all extensor and flexor tendons but lacking coverage of skin and soft tissues (Fig 5).
Result of tubular groin flap covering the entire circumference of the thumb after three weeks
wjps-12-63-g006.jpg
PMC10200088_03_wjps-12-63-g006.jpg
F6
He experienced a recovery of 80% of thumb movements (Fig 6).
PMC10200088_04
Partial degloving on the left palmar surface at the first interphalangeal joint resulting from electrical burn
wjps-12-63-g007.jpg
PMC10200088_04_wjps-12-63-g007.jpg
F7
Physical examination revealed partial function of the flexor tendon, preserved abduction and adduction of the thumb, bone and soft tissue loss with bone exposure, and lack of skin and soft tissue coverage (Fig 7).
Tubular design approach to cover affected area, preserve major blood supply, and prevent ischemia
wjps-12-63-g008.jpg
PMC10200088_04_wjps-12-63-g008.jpg
F8
We preferred to use a tubular design approach to preserve major blood supply and prevent ischemia (Fig 8).
Result of tubular groin flap covering the entire affected after three weeks
wjps-12-63-g009.jpg
PMC10200088_04_wjps-12-63-g009.jpg
F9
The flap was separated three weeks after the surgery under local anesthesia, and thumb function was deemed acceptable with preserved flexor and extensor tendons (Fig 9).
PMC10200088_05
Dry necrosis of distal phalanx, two weeks after right thumb avulsion and partial amputation
wjps-12-63-g010.jpg
PMC10200088_05_wjps-12-63-g010.jpg
F10
After two weeks, the distal phalanx suffered dry necrosis (Fig 10), so we decided to perform a groin flap for skin coverage of the bone and repaired tendons.
Contralateral groin flap covering bone and repaired tendons
wjps-12-63-g011.jpg
PMC10200088_05_wjps-12-63-g011.jpg
F11
An ipsilateral flap was not available due to two previous hernia surgeries the patient had undergone, so we harvested a contralateral flap instead (Fig 11).
Result of groin flap covering the affected area after redundant skin resection at one month
wjps-12-63-g012.jpg
PMC10200088_05_wjps-12-63-g012.jpg
F12
Both the functional and aesthetic results were better than we and the patient expected, considering the injury mechanism and the extent of soft tissue damage (Fig 12).