A degloving injury is a severe form of trauma where a large section of skin and the soft tissue directly beneath it are forcibly separated from the underlying structures, such as muscle or bone. This type of injury is named for its visual similarity to removing a glove from a hand or finger. Because these injuries often involve significant blood loss, tissue damage, and a high risk of infection, they require immediate and specialized medical intervention.
The Mechanism of Degloving Injuries
Degloving is caused by intense, high-energy trauma that applies a strong shearing force to the body’s soft tissues. This force violently rips the superficial layers, including the skin and subcutaneous fat, away from the deeper layer of tissue called the deep fascia. The mechanism is a tearing and sliding motion that separates the layers along their natural planes of attachment, rather than a simple cut.
The forceful separation severs the tiny blood vessels that supply the skin from the deep tissues. Avulsion of these vessels instantly compromises the blood supply to the separated skin flap, leading to tissue death (necrosis) if blood flow is not quickly restored. Degloving most commonly affects the limbs, especially the legs, but can occur on any body part subjected to rotary or tangential trauma, such as in severe motor vehicle accidents or industrial machinery incidents.
Classifying Types of Degloving Trauma
Degloving injuries are broadly categorized into two main types that differ significantly in appearance and treatment needs. The most visually apparent is Open Degloving, where the skin is completely torn away or remains partially attached as a flap. This leaves muscles, tendons, or bone fully exposed, presenting an immediate and severe risk of contamination and blood loss. Hemorrhage control and infection prevention are the first priorities for this type of injury.
The second type is Closed Degloving, also known as a Morel-Lavallée lesion, which is often less obvious but equally serious. In this injury, the skin remains intact, but the tearing force separates the skin and fat from the underlying fascia, creating a pocket. This space quickly fills with blood, lymph fluid, and liquefied fat, forming a collection that can expand. This fluid collection further threatens the viability of the overlying skin by cutting off its blood supply.
Morel-Lavallée lesions frequently occur over areas where the skin is highly mobile against the deep fascia, such as the hip, thigh, or torso. The location of the injury impacts its severity and management due to the different underlying anatomy. Because closed degloving is non-obvious, it can sometimes be overlooked in patients with multiple injuries, leading to delayed diagnosis and increased complications.
Immediate Stabilization and Emergency Care
Initial management focuses on stabilizing the patient and mitigating the risks of shock and infection. Emergency personnel must immediately control active bleeding, which is often profuse in open degloving injuries, typically using direct pressure with a sterile dressing. In cases of uncontrolled, life-threatening hemorrhage, a tourniquet may be applied above the injury site.
For an open injury, the exposed tissues must be protected from contamination to minimize the risk of a severe infection. If the avulsed skin or tissue is available, it must be carefully preserved for potential use in surgery; it should be wrapped in a clean, moist cloth and kept cool, but never placed directly on ice. The medical team will also manage the patient’s pain and treat for traumatic shock, which is characterized by a rapid pulse and pale, clammy skin. Prompt transport to a specialized trauma center is necessary, as the definitive treatment requires complex surgical expertise.
Surgical Treatment and Reconstructive Procedures
Definitive treatment involves complex surgical intervention aimed at covering exposed structures and restoring function. The first step is thorough debridement, where non-viable, contaminated, or dead tissue is surgically removed to prevent infection and promote healing. For open degloving, the surgeon must decide the fate of the avulsed skin flap.
Attempting to reattach the original skin flap is often unsuccessful, as the severed blood vessels usually result in necrosis of the tissue. Instead, the avulsed skin is often “defatted” to remove the damaged subcutaneous tissue and then used as a skin graft to cover the wound bed. A skin graft is a thin layer of skin applied to the wound, which relies on the underlying tissue to establish a new blood supply for survival.
If deep structures like tendons, bone, or joints are exposed, a simple skin graft will not provide enough coverage or padding, requiring a more complex solution. In these cases, a tissue flap is used, which involves transferring skin, fat, and sometimes muscle from a healthy part of the body while keeping its original blood supply intact. The goal of this reconstructive surgery is to ensure a durable, well-vascularized covering for the exposed area.
Closed degloving injuries (Morel-Lavallée lesions) are often treated by draining the accumulated fluid and then removing the damaged tissue and any pseudocapsule that forms around the collection. Due to the severity of the trauma, patients frequently require multiple operations and a lengthy period of rehabilitation. The long-term prognosis depends heavily on the extent of the initial damage and the success of the reconstructive efforts.