Integrated tendon repair and staged skin grafting for a severe forearm degloving injury
Garuun Mohamed Abdikadir, Moise Mvuye Manishimwe, Mahmoud Bakheet Abdulrahman, Fadlalla Ali Khalid, Chinyere Nkemjika Anyanwu, Emeka Godson AnyanwuRationale:
Upper-limb degloving injuries are uncommon but can cause substantial functional impairment, particularly when accompanied by tendon injury. Their management is especially challenging in resource-constrained settings where microsurgical reconstructive options may be limited.
Patient concerns:
A 21-year-old, right-handed man presented 2 hours after a road traffic collision with an extensive degloving injury involving the right forearm, wrist, and dorsal thumb.
Diagnoses:
Examination and operative exploration demonstrated exposed underlying structures and rupture of the flexor digitorum superficialis tendon slips. Radiographs also revealed a concomitant distal humerus fracture.
Interventions:
Following resuscitation, the patient underwent urgent wound exploration, extensive irrigation and debridement, primary tendon repair, and partial wound closure. The residual dorsal thumb defect was subsequently covered with a split-thickness skin graft harvested from the right thigh. The distal humerus fracture was managed conservatively with immobilization.
Outcomes:
The postoperative course was uncomplicated. At 6 weeks, the wounds and skin graft had healed satisfactorily, thumb and finger movements were preserved, and the patient had regained useful hand function following physiotherapy. The concomitant distal humerus fracture remained under conservative management with immobilization during this period.
Lessons:
Early debridement and tendon repair combined with staged split-thickness skin grafting can provide satisfactory wound coverage and early functional recovery in selected upper-limb degloving injuries when microsurgical reconstruction is unavailable.