Theun's Journey: Degloving Injury

Theun was involved in a car accident (Image I) in August 2017. His right, dominant hand got caught between the car seat and the door. As he pulled his hand up to release it, the dorsum of his hand was degloved. He was taken to hospital where the wound was debrided (Image 2) and a split skin graft was applied to the degloved area (Image 3). Unfortunately, a full thickness graft was not done at the time.The risk of having a split skin graft applied to the dorsum of the hand is that the graft will adhere to the underlying tendons and tissue. This will result in the development of extrinsic tightness and an inability to make a fist. Furthermore, the thin coverage does not allow the secondary procedures as it is not possible to release the graft to perform a tenolysis without the need for more major surgery as a full thickness graft will be necessary to cover the wound. This would be costly and it would result in time off work and further hand rehabilitation.