Degloving Injuries: Causes, Treatment, and Long-Term Recovery

A degloving is one of the most extreme and aesthetically disfiguring types of injury. Degloving is a term that describes any situation in which the skin and underlying soft tissues are stripped from the deeper body structures (e.g., fascia, muscle or bone) under force. This type of lesion is aptly named because, in effect it’s like taking a glove off the hand. Injuries are true emergencies that must be expeditiously addressed as they result in extensive tissue damage, compromised vascularity, extreme discomfort and come with the risk of significant morbidities.

Such injuries are more frequently a result of high-energy mechanisms including highway accidents, industrial machine hazards, or crushing mechanisms. As the degloving injuries can be either external or internal, early identification and appropriate management are important for survival as well as healing and ultimate function. In this complete guide, we answer every question you may have ever had about degloving injuries-what they are, how doctors diagnose them, what treatment options are available and what to expect during recovery.

What Is a Degloving Injury?

When the skin and tissues beneath are torn by strong pulling force from objects underneath. This pressure can cause the tissues to lose their blood supply and the tissue dies, or it may cause large amounts of swelling or accumulation excessive internal body fluid. Degloving falls within the definition of avulsion but is more severe in terms of detachment and loss of tissue.

Degloving, simply stated, is defined by when:

• The skin is released from the hobbit.
• 2 The great and lesser saphenous veins and lymphatics are lacerated.
• A significant cleft between layers of the tissue develops.
• The avulsed skin can also be totally detached or partially attached.
• Depending on the stage, degloving may be open or covered by skin.

Types of Degloving Injuries

Degloving injuries are generally classed as either open or closed. Each kind has different symptoms, risks and treatment options.

Open Degloving Injury

This is the more severe form where skin, and in some cases deeper tissues are visibly ripped away. You can have some muscle, bone or tendons visible. Open degloving is commonly associated with:

• Road accidents
• Machinery rollers
• Agricultural tools
• Crush injuries

Open wounds can be of partial or complete types:

• Partial: A portion of the lining is still attached and may be receiving blood supply.
• Rephrase: The skin is completely removed and no longer viable.

Open degloving injuries are emergency medical conditions and usually these cases need to be treated surgically.

Closed Degloving Injury

This, known as internal degloving or Morel-Lavallée injury, happens when the skin stays put but deeper tissues shear away from the fascia below. This forms a cavity which becomes filled with blood, lymph, and fat.

Close degloving injuries can be seen in:

• The hip
• Thigh
• Pelvis
• Knee
• Lower back

Since the skin appears healthy from above, these can be overlooked or diagnosed late, resulting in chronic discharge of fluid, infection and necrosis.

Common Causes of Degloving Injuries

Degloving injuries usually result from high-energy trauma or severe shearing force. Common causes include:

Road Traffic Accidents

Among the most common roots of degloving-particularly to the legs or arms-are motorbike mishaps, bicycle accidents and car crashes in which skin is either dragged along a road due to friction, pulled away from underlying tissue or simply crushed.

Industrial and Workplace Accidents

Large equipment such as conveyor belts, rollers and rotating components can snag cloth or skin, yanking tissue off forcefully in a injury.

Agricultural Equipment

Machinery used on farms is a major cause of serious degloving injuries, which may occur primarily in the hand, forearm or lower limb.

Sports Injuries

Blunt trauma in sports, such as skiing or contact sports sometimes result in internal degloving from sudden shearing forces.

Crush Injuries

An arm or leg can be caught between two surfaces and the force is enough strength to separate the skin from underlying tissue.

Falls or High-Impact Blunt Trauma

A hard fall may generate sufficient pressure to induce internal degloving, especially in the area of pelvis and thighs.

Symptoms of Degloving Injuries

Symptoms vary, depending on whether the injury is open or closed.

Open Degloving Symptoms

• Apparent tearing or stripping of the skin
• Bare muscle, bone or fat metastases
• Severe bleeding
• Extreme pain
• Swelling and bruising
• Discoloration of the skin (blue or pale or black)
• Foul smell at wound site if it becomes infected
• Numbness if nerves are injured

Closed Degloving Symptoms

• Swelling in the affected area
• A soft lump this could be in any part of the body and may be shown as a swelling, spot or stain on the skin.
• Significant bruising
• Excessively mobile skin over the deep tissues
• Pain or tightness
• Warmth or redness if infected
• Gradual buildup of fluid
• Closed wounds can have a delayed (days to weeks after the trauma) presentation.

How Degloving Injuries Are Diagnosed

Physical examination is crucial in the diagnosis of degloving injuries, as well as imaging and assessing skin viability. Doctors follow several steps:

Clinical Examination

• Examine the skin for lacerations, ecchymosis, and viability of flaps.
• Palpate the site to confirm whether fluid is found.
• Examine for sensation, pulses and movement.
• Check for associated injuries like fractures or vascular injury.

Imaging Tests

Doctors often use:

• Ultrasound – to identify fluid pockets inside the body.
• CT Scan – to determine depth of tissue disruption.
• MRI – best for diagnosing internal degloving injuries and extent.
• Doppler Test – To check blood flow to injured tissues.

Skin Viability Assessment

The doctor checks:

• If skin bleeds after being pricked
• Temperature of the skin flap
• On coloration (pink=good, black=necrosis)

Well executed diagnosis enables adequate management and minimizes the probability of complications.

Treatment of Degloving Injuries

Management varies according to severity, site and class of degloving injury. Such injuries almost always demand immediate and multidisciplinary attention.

Step 1: Emergency Management

• Control bleeding
• Manage the patient (particularly if multi-trauma)
• Debride the wound to decrease infection.
• Pain management and IV fluids
• Tetanus protection and antibiotics

Step 2: Surgical Intervention

• Most degloving injuries require surgery. Treatment options include:

Debridement

• Removal of all necrotic, contaminated, and compromised tissue is the initial management to prevent complications and set the stage for reconstruction.

Reattachment of Skin (if viable)

• If the skin that was pulled away is still receiving a blood supply, doctors are able to reattach it.

Skin Grafting

• When the patient’s own skin is not used again, the physician turns to some other part of the body for skin:
• Split-thickness skin graft
• Full-thickness graft

Flap Reconstruction

For extensive injuries, surgeons use:

• Local flaps
• Regional flaps
• Free flap transfers (microvascular surgery)

These offer improved coverage, perfusion, and functional sustainability.

Vacuum-Assisted Wound Therapy

• Negative pressure wound therapy helps:
• Remove fluid
• Improve healing
• Prepare the wound for grafting

Treatment for Closed Degloving

Depending on severity:

• Compression bandages
• Needle aspiration
• Drain insertion
• Sclerotherapy: Medicine is injected into the space to close it up.
• Capsulectomy (for chronic lesions)

Recovery and Rehabilitation

The healing process may last weeks or months, and sometimes it will be years if the degloving is severe.

Physical Rehabilitation

Patients need physiotherapy to regain:

• Movement
• Strength
• Flexibility
• Joint mobility

Wound Care

• Dressing changes, surveillance of infection and wound status are crucial.

Psychological Support

Physical and mental trauma is also experienced in degloving injuries. The following issues may need to be explained and addressed for patients:

• Appearance changes
• Loss of function
• Long recovery period

Functional Recovery

Some patients may:

• Return to full activity
• Need job modifications
• Lose partial function
• Require assistive devices
• Undergo multiple surgeries

Complications of Degloving Injuries

These injury may cause life-threatening complication without prompt and correct treatment.

Common Complications

• Skin necrosis
• Infection or sepsis
• Permanent scarring
• Long-term pain
• Reduced limb function
• Chronic fluid collections
• Nerve damage
• Joint stiffness
• Amputation (in severe cases)
• Psychological trauma

Prognosis

The prognosis depends on:

• How fast was the injury fixed
• Extent of tissue loss
• Occurrence of the fractures or vascular injury
• Patient’s general health
• Quality of surgical reconstruction
• Consistency of rehabilitation

The great majority of patients recover with adequate medical care, but some have chronic disabilities or need further surgery.

Prevention of Degloving Injuries

Not all injuries can be avoided but risk can be minimised with adequate safety precautions Maybe we should handle this differently.

Road Safety

• Wear protective gear
• Follow traffic rules
• Avoid overspeeding
• Use seat belts

Industrial Safety

• Wear fitted clothing
• Follow machinery safety guidelines
• Do not put fingers or legs into the moving parts
• Undergo proper equipment training

Sports Safety

• Use protective padding
• Train under supervision
• Understand and follow safety protocols

Workplace Awareness

A commitment to periodic safety drills and education can eliminate many cases.

Frequently Asked Questions

Conclusion

A degloving injury is a Serious and Morbid type of tissue Trauma. This injury is potentially life threatening and that it will need to be practitionered in an expert sterile induced environment with trauma surgical expertise followed by long-term rehabilitation. The early identification of the disease, accurate diagnosis and appropriate treatment could significantly increase the possibility of recovery and restoration of function. Good old fashioned awareness and safety, especially on the road and in businesses, can greatly minimize the risk of degloving injuries.

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