Urbaniak Grade III degloving injuries in which the amputated portions were not available for attempted replantation in patients who refused amputation were treated with heterodigital flaps from either ulnar middle finger (for index and ring defects) or ring finger (for small finger defects). The donor sites were treated with full thickness skin grafts and long-term results were reviewed in 6 patients. Mean follow-up was 20 months. All flaps survived but skin graft loss was 30% with complete healing by secondary intention in all patients. Total active motion (TAM) was 190° in digits with intact tendons and 90° with absent tendons. Two-point discrimination was on average 8.3 mm in transposed flaps. Half of the patients reported cold intolerance, one patient developed a scar contracture which required Z-plasty, and one patient ultimately regretted not having an amputation.
This represents another tool for resurfacing grade III ring avulsions when replantation is not possible. Sensibility is acceptable and sacrificing the ulnar border of the digit is required which results in impaired sensibility and a contour deformity of the donor digit on the ulnar side. For patients who demand salvage of the digit, which is reasonable for the ulnar digits participating in power grip or the long finger, this is yet another option which allows a single operation as opposed to tubed flaps or thoraco-abdominal flaps. However, replantation of the amputated part, when possible, helps avoid donor site morbidity to adjacent digits and is becoming more and more successful (Brooks D, Buntic RF, et al., Ring avulsion: injury pattern, treatment, and outcome. Clin Plast Surg 34:187-95, 2007.).