Degloving Causes and Treatment

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.

What Does Degloving Mean?

Degloving, medically known as avulsion, occurs when skin and the associated subcutaneous tissue are forcibly detached from underlying structures like muscle or bone.

This can happen through extreme friction or as a result of a traumatic pulling or shearing force. Degloving injuries are most frequently seen in industrial accidents, motor vehicle crashes, and severe falls.

How Painful Is a Degloving Injury?

Degloving injuries are extremely painful due to the significant trauma to the soft tissues and nerves. Immediate and intense pain is typical, followed by ongoing discomfort during the healing and recovery process.

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

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.

Complications

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.

Can You Recover from Degloving?

Recovery from a degloving injury depends on the severity and location of the injury, as well as the promptness and effectiveness of medical treatment.

While minor degloving injuries can heal well with proper medical care, severe cases might require long-term treatment and rehabilitation.

Physical therapy, and sometimes psychological counseling, are necessary parts of recovery due to the traumatic nature of the injury and its impact on mobility and daily activities.

Is Degloving Serious?

Degloving is considered a serious medical emergency that requires immediate treatment to prevent further damage and complications such as infection, severe blood loss, and potential loss of the affected limb or digit. Timely medical intervention is crucial for a positive outcome.

How Does Finger Degloving Happen?

Finger degloving is commonly caused by rings getting caught on objects while the hands are in motion, pulling the skin and tissue from the finger.

This is why these injuries are sometimes referred to as “ring avulsion” injuries. Industrial workers and those operating heavy machinery are particularly at risk.

Does Degloving Require Surgery?

Yes, degloving injuries often require surgical intervention to repair the damage. The treatment typically involves cleaning the wound, removing any nonviable tissue, and repairing the affected area with skin grafts or flaps to cover the exposed tissues.

In severe cases, reconstructive surgery may be necessary to restore function and appearance as much as possible.

Tips for Preventing and Managing Degloving Injuries

• Wear appropriate safety gear: Utilize gloves and protective clothing, especially in environments with machinery or when participating in high-risk activities.
• Remove jewelry: Always remove rings and other jewelry when working with machinery or when involved in sports and physical activities.
• Stay alert: Being aware of your surroundings and understanding the risks in your environment can help prevent accidents.
• Follow safety protocols: Always adhere to safety guidelines and procedures, particularly in workplaces with heavy machinery.
• Emergency response plan: Know the basics of first aid and have an emergency response plan in place, especially in high-risk environments.

FAQs About Degloving Injuries

Q1: How long does it take to heal from a degloving injury?

A1: Healing times vary widely depending on the injury’s severity; minor injuries may heal within a few weeks, while severe ones may take months or even longer, requiring multiple surgeries.

Q2: Can degloving be completely cured?

A2: While many people can recover significantly, complete recovery may not be possible in cases of severe degloving, especially if there is permanent damage to nerves or muscles.

Q3: Are there any psychological impacts of degloving injuries?

A3: Yes, due to the traumatic nature of the injury and its potential long-term physical effects, psychological impacts such as PTSD, anxiety, and depression are common among survivors.

Q4: What is the first thing to do if a degloving injury occurs?

A4: Immediate medical attention is crucial. Apply pressure to control bleeding and cover the injury with a clean cloth or bandage until professional medical help is available.

Conclusion

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.