A degloving injury is a severe trauma where a large section of skin and the soft tissue beneath it are torn away from underlying structures like muscle, connective tissue, or bone. Resembling the removal of a glove, these injuries often involve significant blood loss and tissue damage.
How Degloving Injuries Happen
Degloving injuries result from high-energy trauma that generates shearing, crushing, or avulsion forces. These forces separate the skin and subcutaneous fat from the deep fascia, the fibrous layer covering muscles. This tearing can disrupt the blood vessels that supply the skin, leading to tissue death.
Common scenarios for these injuries include motor vehicle accidents, where a limb might be run over or caught. Industrial and farm machinery accidents, where a body part becomes entangled, are also frequent causes. Falls from heights, sports mishaps, and animal bites can also cause degloving injuries.
Different Types of Degloving Injuries
Degloving injuries are categorized into two types: open and closed. An open degloving injury, also known as external degloving, occurs when skin and tissue are visibly ripped away, exposing underlying muscles, tendons, or bones. The detached skin might be completely removed or remain partially attached as a flap.
In contrast, a closed degloving injury, often called a Morel-Lavallée lesion, involves the separation of skin and subcutaneous tissue from deeper structures without an open wound. This internal detachment creates a space that can fill with blood, lymph fluid, and liquefied fat, leading to swelling and bruising under the intact skin. Closed degloving injuries are more common around the hip, thigh, and knee, areas where the skin has more natural mobility and can be easily detached from the bone.
Recognizing a Degloving Injury
Recognizing a degloving injury depends on its type, with open injuries having more obvious signs. Open degloving injuries present with extreme pain, deep lacerations, and visible separation of skin and soft tissue. Underlying structures like bone, muscle, or tendons may be exposed, and severe blood loss can occur.
For closed degloving injuries, the signs are less apparent, as the skin remains intact. Symptoms may include pain, bruising, and swelling in the affected area. Skin discoloration can develop as the tissue loses blood supply. Nerve damage can also cause decreased sensation.
Medical Care for Degloving Injuries
Medical care for degloving injuries involves immediate surgical intervention, especially for open or large closed injuries. The goal is to assess damage and prevent infection. Surgeons perform debridement, the removal of dead, damaged, or contaminated tissue to create a clean wound bed.
If the avulsed skin is healthy and retains a blood supply, it may be reattached through a procedure called replantation or revascularization. When reattachment is not possible or the skin is not viable, skin grafting is commonly performed. This involves transferring healthy skin from another part of the patient’s body (a donor site) to cover the exposed area. Both split-thickness grafts, which include the top layer of skin and a portion of the dermis, and full-thickness grafts, which involve all layers of the skin, may be used depending on the wound.
The Recovery Process
Recovery from a degloving injury is prolonged and requires a multidisciplinary approach. After initial surgical procedures, patients undergo wound care to prevent infection and promote healing. This may involve regular dressing changes and negative pressure wound therapy to prepare the wound bed for grafting.
Physical therapy begins, focusing on restoring mobility, strength, and function to the affected area. Patients may also need occupational therapy to adapt to daily activities with any lasting limitations. While many individuals achieve good functional outcomes, long-term considerations can include scarring, reduced sensation, and chronic pain.