The term “degloving” describes a severe soft tissue trauma resulting from the forceful separation of the skin and its underlying fat layers from deeper structures like muscle, fascia, or bone. The name is derived from the injury’s appearance, which resembles a glove being pulled off a hand, often exposing the tissue beneath.
Understanding the Injury
Degloving is an avulsion injury where a significant section of skin and subcutaneous tissue are forcibly sheared away from the deep fascia. This shearing force causes layers that are normally tightly bound together to slide apart, creating a large space between them. The trauma occurs at the level of the superficial fascia, disrupting the fine network of blood and lymphatic vessels.
The resulting separation severely compromises or completely severs the blood supply to the detached skin and fat flap. Without an adequate blood supply, the separated tissue rapidly becomes ischemic, lacking oxygen, and may ultimately die. This loss of viability turns the wound into a complex reconstructive challenge.
Common Causes and Mechanisms
The injury mechanism involves a high degree of tangential or shearing force, necessary to overcome the connective strength of the body’s fascial layers. Degloving often results from high-energy trauma, such as motor vehicle accidents where the body is dragged or scraped across a hard surface. This scraping generates the powerful friction and shearing necessary to strip the skin away.
Industrial and farming accidents involving machinery entanglement are another frequent cause, particularly where a limb is caught and pulled into rollers or gears. Crush injuries, such as a vehicle tire rolling over a limb, can also create the intense forces required to cause internal degloving. These injuries are most common on the extremities, especially the lower limbs, but can occur anywhere on the body.
Classifying the Injury and Initial Triage
Medical professionals categorize degloving injuries into two main types, which guides the initial assessment and treatment.
Open Degloving Injury
This type involves the skin and fat being completely torn away or left hanging as an open flap, exposing the underlying muscle, bone, or tendons. This is immediately apparent and typically involves significant external bleeding and wound contamination. Triage focuses on managing severe blood loss and covering the exposed tissues. The viability of the separated skin flap must be quickly assessed, as tissue that has lost its blood supply must be removed to prevent necrosis.
Closed Degloving Injury
Often referred to as a Morel-Lavallée lesion, the skin remains intact, but internal shearing creates a large, fluid-filled cavity beneath it. This space fills with blood, lymph fluid, and liquefied fat, causing swelling and bruising. Diagnosis often requires imaging like MRI to confirm the fluid collection. Initial management may involve draining the fluid and applying compression.
Surgical Repair and Reconstruction
The definitive treatment for degloving injuries is surgical, often requiring complex reconstructive procedures due to the non-viability of the original tissue. The separated skin flap frequently cannot be stitched back into place because the shearing mechanism has destroyed the necessary microcirculation. The first surgical priority is debridement, which is the careful removal of all dead, contaminated, or non-viable tissue to create a clean, healthy wound bed.
Once the wound is clean, surgeons must provide stable soft tissue coverage over the exposed structures using advanced techniques.
Skin Grafts
A common approach is a skin graft, which involves transplanting a thin layer of skin from a healthy donor site on the patient’s own body. A split-thickness graft includes the epidermis and a portion of the dermis and is used for large, flat areas. A full-thickness graft includes all skin layers and is preferred for areas requiring a better cosmetic result.
Flap Surgery
For more complicated wounds, especially those over joints, tendons, or bone where simple grafts would not survive, flap surgery is necessary. A flap involves transferring skin, underlying fat, and muscle, along with its own dedicated blood supply. This provides a robust and vascularized covering necessary for long-term function and to resist infection. Patients with significant degloving injuries often face multiple surgeries and an extended period of recovery, which typically includes extensive physical therapy.