We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferential...We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferentially to the dorsal aspect with loss of the skin of the terminal phalanx and part of the proximal phalanx. The nail and germinal matrix were lost with exposure of the bone and extensor pollicis longus tendon insertion. The thumb was totally covered with a combination of two flaps: Moberg flap with V-Y advancement was used to cover most of the volar surface of the thumb and reverse adipofascial cross finger flap from the adjacent index finger was used to cover the dorsal surface and the tip of the thumb. The reverse adipofascial cross finger flap was covered with split thickness skin graft. Three weeks later this flap was divided and the thumb was mobilized freely. The patient had a full range of movement of the thumb and index finger with few settings of physiotherapy postoperatively. We recommend combining both of these flaps to reconstruct degloving injury of the thumb as they provide near adjacent tissue of similar texture, preserve sensation at the volar aspect of the thumb and also avoid the complications of the distant flaps.展开更多
Objective To review current knowledge of the Morel-Lavallee lesion （MLL） to help clinicians become familiar with this entity.Familiarization may decrease missed diagnoses and misdiagnoses.It could also help steer th...Objective To review current knowledge of the Morel-Lavallee lesion （MLL） to help clinicians become familiar with this entity.Familiarization may decrease missed diagnoses and misdiagnoses.It could also help steer the clinician to the proper treatment choice.Data sources A search was performed via PubMed and EMBASE from 1966 to July 2013 using the following keywords：Morel-Lavallee lesion,closed degloving injury,concealed degloving injury,Morel-Lavallee effusion,Morel-Lavallee hematoma,posttraumatic pseudocyst,posttraumatic soft tissue cyst.Study selection Chinese and English language literatures relevant to the subject were collected.Their references were also reviewed.Results Morel-Lavallee lesion is a relatively rare condition involving a closed degloving injury.It is characterized by a filled cystic cavity created by separation of the subcutaneous tissue from the underlying fascia.Apart from the classic location over the region of the greater trochanter,MLLs have been described in other parts of the body.The natural history of MLL has not yet been established.The lesion may decrease in volume,remain stable,enlarge progressively or show a recurrent pattern.Diagnosis of MLL was often missed or delayed.Ultrasonography,computed tomography,and magnetic resonance imaging have great value in the diagnosis of MLL.Treatment of MLL has included compression,local aspiration,open debridement,and sclerodesis.No standard treatment has been established.Conclusions A diagnosis of MLL should be suspected when a soft,fluctuant area of skin or chronic recurrent fluid collection is found in a region exposed to a previous shear injury.Clinicians and radiologists should be aware of both the acute and chronic appearances to make the correct diagnosis.Treatment decisions should base on association with fractures,the condition of the lesion,symptom and desire of the patient.展开更多
文摘We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferentially to the dorsal aspect with loss of the skin of the terminal phalanx and part of the proximal phalanx. The nail and germinal matrix were lost with exposure of the bone and extensor pollicis longus tendon insertion. The thumb was totally covered with a combination of two flaps: Moberg flap with V-Y advancement was used to cover most of the volar surface of the thumb and reverse adipofascial cross finger flap from the adjacent index finger was used to cover the dorsal surface and the tip of the thumb. The reverse adipofascial cross finger flap was covered with split thickness skin graft. Three weeks later this flap was divided and the thumb was mobilized freely. The patient had a full range of movement of the thumb and index finger with few settings of physiotherapy postoperatively. We recommend combining both of these flaps to reconstruct degloving injury of the thumb as they provide near adjacent tissue of similar texture, preserve sensation at the volar aspect of the thumb and also avoid the complications of the distant flaps.
文摘Objective To review current knowledge of the Morel-Lavallee lesion （MLL） to help clinicians become familiar with this entity.Familiarization may decrease missed diagnoses and misdiagnoses.It could also help steer the clinician to the proper treatment choice.Data sources A search was performed via PubMed and EMBASE from 1966 to July 2013 using the following keywords：Morel-Lavallee lesion,closed degloving injury,concealed degloving injury,Morel-Lavallee effusion,Morel-Lavallee hematoma,posttraumatic pseudocyst,posttraumatic soft tissue cyst.Study selection Chinese and English language literatures relevant to the subject were collected.Their references were also reviewed.Results Morel-Lavallee lesion is a relatively rare condition involving a closed degloving injury.It is characterized by a filled cystic cavity created by separation of the subcutaneous tissue from the underlying fascia.Apart from the classic location over the region of the greater trochanter,MLLs have been described in other parts of the body.The natural history of MLL has not yet been established.The lesion may decrease in volume,remain stable,enlarge progressively or show a recurrent pattern.Diagnosis of MLL was often missed or delayed.Ultrasonography,computed tomography,and magnetic resonance imaging have great value in the diagnosis of MLL.Treatment of MLL has included compression,local aspiration,open debridement,and sclerodesis.No standard treatment has been established.Conclusions A diagnosis of MLL should be suspected when a soft,fluctuant area of skin or chronic recurrent fluid collection is found in a region exposed to a previous shear injury.Clinicians and radiologists should be aware of both the acute and chronic appearances to make the correct diagnosis.Treatment decisions should base on association with fractures,the condition of the lesion,symptom and desire of the patient.
