Reconstruction of Completely Circumferentially Degloved Thumb Using Omental Flap and Tubular Split-thickness Skin Graft

Various types of thin flaps have been used for reconstruction in cases of complete circumferential degloving injuries of digits (Urbaniak classification class III). The omental flap has extensive, pliable, and well-vascularized tissue and helps prevent bone resorption of the distal phalange that can result from avascular necrosis. A 31-year-old right-handed man with class III left thumb injury and compartment syndrome of the left forearm was treated successfully with a free omental flap wrapped around the thumb and then covered with a tubular split-thickness skin graft. The postoperative course was good, except that the distal third of the phalange of the thumb was resected because of insufficient omentum volume transplanted to the thumb tip resulting from omental volume bias in the distal part of the thumb. Bone scintigraphy 1 year after injury showed technetium-99m accumulation in the remaining two-thirds of the distal phalange, although there was no blood supply before the reconstruction. The advantages of our treatment method are that the thickness of the reconstructed digits can be adjusted by the amount of the omental flap. Skin grafting can be simplified; and with multiple digital injuries, separated fingers can be reconstructed in a single operation by wrapping each digit with a divided omental flap. Use of the free omental flap and tubular split-thickness skin graft is a therapeutic reconstruction option for Urbaniak class III injury.