Degloving is the term used when the structures beneath the skin and tissue layer become visible due to tearing apart of the upper layers. Muscle, connective tissue or bone are exposed. It also causes damage to the blood vessels.
It occurs due to sudden application of shearing force that causes stretching of skin and subcutaneous tissue to detach voilently from the fascial layers.
They mostly occur in the lower extremeties, face and scalp but can occur in other parts too. Sometimes the cuts may rip a few layers of the skin and if a few layers of skin are intact, new skin will grow at the bottom and surrounding part of the wound. From there on, it will heal upwards.
It can be caused by- trafﬁc accidents, animal bites, injury during sports, occupational accidents, falling from height etc.
Are There Different Types of Degloving?
Degloving, also called avulsion can be of two types.
1. Open Degloving
When the skin and tissue are separated from the rest of the structure, uncovering muscles, bone, and connective tissue into the open, it is called open degloving.
This can occur due to various reasons and cause severe blood loss and serious infection which calls for urgent care.
It mostly occurs in the legs, torso, face, scalp.
It can be complete (anatomical) or partial depending upon the extent of parts exposed.
2. Closes Degloving
This involves the formation of space under the skin and tissue top layers due to their separation from underlying layers. It is a soft tissue injury in which subcutaneous tissue is separated forming space.
These wounds are not very common. Since it is mostly internal and symptoms are not clear, if treatment is not proper, it leads to a diseased state. The term used for the cavity ‘Morel-Lavellée lesions’ when they occur over the greater trochanter. Also, they are associated with pelvic fractures.
The cavities are ﬁlled with body ﬂuids (hematoma) and liquiﬁed fat.
There are other types of classiﬁcations as well such as Arnez classiﬁcation.
Treatment varies with various factors such as – location, type, and extent of the injury. This in turn depends upon the magnitude of force caused by abrasion, torsion, and compression processes. It also depends upon how long it takes before the treatment begins.
One must be taken to a healthcare center where advanced treatment for such traumatic injuries is provided. Damaged tissue must be properly assessed. The wound must also be cleaned properly using pulsatile lavage or it might be contaminated putting at risk of disease.
Treatment is different for both types of degloving.
1. Open Degloving Treatment
It may involve a number of surgeries for gaining back the normal functioning of part. Procedures might involve-
1. Reattachment of the severe skin or body part.
2. Amputation ( removal of limb).
3. Skin grafting/transplant from some other part of the body.
4. Replantation or revascularisation.
If the ﬂap of skin is attached, it might try to function and live by obtaining nutrients from the pedicle. Detached skin can be used for skin grafts.
It is a principle of treatment to preserve as much structure as possible for return of function and the quality of skin cover should be good.
2. Closed Degloving Treatment
For minor injuries, bandages and rest for some time with proper medication is enough. Physiotherapy is also suggested. But for major injury treatment might include-
1. Removing the damaged and dead tissue structure
2. Draining ﬂuid accumulated in lesion
3. Sclerotherapy (medicine eg- talc injected in blood and lymph vessels for shrinkage)
4. Hematoma formed must be emptied off the toxic material.
Morel-Lavellée lesions can be treated with the open debridement technique (removal of damaged or dead tissue) with or without negative-pressure wound therapy. It is used to the closing wounds to prevent the risk of disease, assist in drainage of toxic materials and reduce swelling. However, it is not widely popular.
Degloving injuries can be life-threatening if neglected. Since the wound might be open and deep, infections are quite probable. If lesions are not cleaned, it might cause skin necrosis later on. Tissue death can occur in severe cases. Injuries not treated on time can result in necrotizing fasciitis, also called ﬂesh eating disease as well.
If one experiences effects such as fever, body aches, edema of the wound, redness around the wound, etc., they must consult the doctor. For immediate management, clean the wound with the application of antibiotic medication and cover it up.
Degloving injuries are a serious issue and can be destructive. In such traumatic cases, immediate treatment is advised with proper rest and care. In the case of closed degloving, early diagnosis is very crucial. Providing cover as quickly as possible is a must in order to reconstruct the skin and retain functioning.
The avulsed tissue is must be converted to skin graft by removing the subcutaneous fat tissues. It is a simple and effective method. Hygiene is also very important in order to prevent infections and other possible diseases. One must not ignore the signiﬁcance of physical therapy.