Degloving injuries are severe forms of soft tissue trauma where layers of skin and underlying tissue are forcibly separated from the muscle and bone beneath. These injuries can be life-threatening and require immediate medical attention due to significant blood loss and tissue damage.
What is a Degloving Injury?
A degloving injury occurs when the skin and subcutaneous tissue (the layer of fat and connective tissue beneath the skin) are torn away from the deeper structures, such as muscle, fascia, or bone. The term “degloving” describes how the skin is peeled back, similar to removing a glove. This separation disrupts the blood supply to the detached skin, which can lead to tissue death if not addressed promptly.
There are two main types of degloving injuries: open and closed. In an open degloving injury, the skin is completely ripped away, exposing the underlying muscles, tendons, or bones. Conversely, a closed degloving injury, sometimes called a Morel-Lavallée lesion, involves the separation of skin and subcutaneous tissue internally, with the outer skin remaining intact. This internal separation creates a cavity that can fill with blood, lymph fluid, and liquefied fat, often appearing as bruising and swelling on the surface.
How Degloving Injuries Occur
Degloving injuries result from high-energy trauma, where force causes a shearing or tearing action on the skin and underlying tissues. Motor vehicle accidents are a frequent cause, especially those involving pedestrians or motorcycle riders who may be dragged across a surface. Industrial accidents, such as those involving machinery like conveyor belts or rotating equipment, can also lead to these injuries when a limb becomes caught.
Crush injuries, falls from significant heights, and even animal bites can generate the necessary forces to cause degloving. The biomechanics involve a combination of tangential forces, which pull the skin in one direction, and compression, which traps the tissue. This mechanism can occur on any part of the body, though the legs are a common site for these injuries.
Medical Treatment for Degloving Injuries
Treatment for degloving injuries is complex and depends on the injury’s severity, location, and type. Initial medical management focuses on stopping bleeding and thoroughly cleaning the wound to prevent infection. This often involves debridement, removing damaged or contaminated tissue to prepare the wound for healing.
Surgical intervention is necessary for open degloving injuries. Surgeons may attempt to reattach viable skin if its blood supply can be restored. More commonly, skin grafting is performed, using healthy skin from another part of the patient’s body to cover the exposed area. For larger defects, flap surgery may be required, transferring tissue that maintains its own blood supply.
For closed degloving injuries, or Morel-Lavallée lesions, treatment varies based on the size and chronicity of the fluid collection. Smaller, acute lesions might be managed with compression and aspiration to drain accumulated fluid. Larger or chronic lesions, particularly those with a fibrous capsule, may require surgical drainage and debridement to remove the fluid and any dead tissue. Preventing infection is a continuous concern, often requiring antibiotics.
The Recovery Process and Prognosis
Recovery from a degloving injury is a prolonged and challenging process, involving an extended hospital stay and multiple surgical procedures. Patients undergo physical and occupational therapy to regain function, mobility, and strength in the affected limb. This rehabilitation is important for restoring movement and adapting to any changes in physical ability.
Significant scarring is a common outcome, and the injured area’s cosmetic appearance may be altered. Potential complications during recovery include chronic pain, nerve damage leading to numbness or weakness, and persistent swelling (lymphedema) due to damaged lymphatic vessels. Infection, including osteomyelitis (bone infection), also remains a concern.
The long-term prognosis for a degloving injury varies based on its initial extent, location, and how quickly treatment was initiated. While many achieve a good recovery with dedicated medical and rehabilitative care, some may experience lasting functional deficits or chronic issues. The psychological impact of such a severe injury can be considerable, requiring support throughout the healing journey.