Salvaging the Right Middle Finger with an Abdominal Flap Following Degloving Injury and Traumatic Amputation at the DIP Joint: A Case Report

Abstract

Degloving injury represents one of the most challenging forms of hand trauma. Various salvage strategies have been described in the literature, including primary reattachment of avulsed skin, reconstruction using free flaps and full-thickness skin grafts (FTSG), as well as replantation and microvascular revascularization, with the choice of technique depending on the specific characteristics and severity of the injury. However, no single reconstructive method has been universally established as the gold standard; therefore, treatment should be individualized with the primary aim of preserving tissue viability and optimizing functional outcomes. A 39-year-old man was referred from a type B hospital in Parepare, presenting with an open injury of the right middle finger following a ring avulsion injury. The injury occurred when the ring worn on the patient’s middle finger became caught on the metal handle of a pickup truck while he was stepping out of the vehicle, resulting in avulsion of the skin and subcutaneous tissue of the affected digit. At the time of injury, the patient was unaware of the detached soft tissue, and the avulsed tissue was not retrieved or brought to the hospital. The patient initially presented to a type C hospital for primary management, was subsequently referred to a type B hospital, and was finally transferred to Makassar for definitive treatment. Skin loss due to traumatic amputation. The patient underwent abdominal flap reconstruction. The results show that the salvage procedure successfully preserved the right middle finger up to the level of the middle phalanx, maintaining digit length despite residual postoperative stiffness. Initial management and available healthcare facilities play a crucial role in determining the feasibility of replantation as well as the selection of appropriate salvage reconstructive options for degloving injuries.