A degloving injury is a severe medical condition where layers of skin and underlying soft tissue are forcefully torn away from the body’s deeper structures, such as muscle, fascia, or bone. The term “degloving” describes the injury’s appearance, resembling how a glove is removed from a hand. Such injuries require immediate and specialized medical attention because they can lead to considerable blood loss, heightened infection risk, and long-term complications.
What is a Degloving Injury?
A degloving injury, also known as an avulsion, involves the forceful separation of the skin and subcutaneous tissue from the underlying structures. This separation disrupts the blood supply to the detached skin, even if it remains partially connected as a flap. While it can affect any part of the body, it holds particular significance in the hand due to its complex anatomy and vital role in daily function.
When a hand is degloved, the skin, fat, and connective tissue are pulled away from the muscles, tendons, and bones. This exposes delicate internal components like tendons and bone. The degree of separation varies, from partial detachment where some skin remains connected, to complete avulsion where the skin is entirely removed. Complete detachment means the degloved skin loses its blood supply, making it non-viable without immediate intervention.
How Degloving Injuries Occur
Degloving injuries typically result from high-energy trauma involving significant compression, shearing, and tearing forces, causing skin and soft tissues to separate from underlying structures. For hand injuries, common scenarios include industrial accidents with heavy machinery, such as conveyor belts or roller machines, where the hand can get caught and pulled.
Road traffic accidents are another frequent cause, often occurring when a vehicle tire runs over an outstretched hand or forearm, or when a person is ejected and drags along the pavement. A distinct type of degloving injury specific to the hand is ring avulsion, where a ring on a finger gets caught on an object, and the sudden, powerful force pulls the skin and soft tissue off the finger, sometimes resulting in complete amputation of the digit.
Immediate Impact and Medical Response
Upon sustaining a degloving injury to the hand, immediate visual signs include exposed muscles, tendons, or bone. The detached skin may appear as a loose flap or be completely absent, leaving underlying structures vulnerable to contamination and further damage.
Immediate medical attention is essential to manage potential complications such as significant blood loss and a high risk of infection. Emergency medical services prioritize controlling any profuse bleeding, often by applying direct pressure to the wound with a clean cloth or sterile dressing. If the degloved skin is completely detached, it is typically preserved and transported with the patient, similar to an amputated limb, by wrapping it in gauze, placing it in a sealed bag, and keeping it cool without direct ice contact. Protecting the exposed tissue from further contamination is also an immediate concern, usually achieved by covering the wound with a sterile dressing.
Treatment and Recovery Outlook
Treatment for degloving hand injuries primarily focuses on preserving viable tissue and restoring function. Surgical intervention is almost always necessary, and the approach depends on the injury’s severity and the viability of the degloved skin. If the skin flap is still partially attached and has a preserved blood supply, surgeons may attempt to reattach it.
More commonly, if the original skin is not viable or completely detached, skin grafting procedures are performed, often using skin from other parts of the patient’s body to cover the exposed areas. This process may involve multiple surgeries and a lengthy hospitalization period. Recovery from a degloving injury is challenging, often requiring extensive physical therapy to regain strength, flexibility, and overall hand function. Potential complications include infection, nerve damage leading to reduced sensation, and the formation of scar tissue that can limit movement.