Understanding degloving injuries
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Degloving injuries are complex and potentially devastating. Early recognition, prompt surgical intervention, and a multidisciplinary approach are essential to optimize patient outcomes. Continued research and development of evidence-based guidelines are needed to improve the management and prognosis of these challenging injuries.
Degloving injuries are severe traumatic events where the skin and subcutaneous tissues are forcibly separated from the underlying structures such as fascia, muscles, or bones. These injuries are often associated with high-energy impacts and can result in significant morbidity if not managed promptly and effectively. This article aims to provide a comprehensive overview of degloving injuries, their causes, clinical presentation, and management strategies.
Causes and Mechanisms
Degloving injuries typically occur due to high-energy trauma, such as motor vehicle accidents, industrial accidents, or farm machinery incidents. The skin is subjected to forces like torsion, crush, or avulsion, leading to the shearing of soft tissues along one or multiple planes1 4 7. In children, these injuries are increasingly common and often associated with fractures1.
Types of Degloving Injuries
Degloving injuries can be classified into open and closed types. Open degloving injuries involve visible detachment of the skin, while closed degloving injuries, also known as Morel-Lavallée lesions, involve separation of the skin from underlying tissues without an external wound3. Closed degloving injuries are particularly challenging to diagnose and may be overlooked in patients with multiple injuries3.
Clinical Presentation
Patients with degloving injuries present with extensive skin and subcutaneous tissue detachment. The injury may expose underlying structures such as tendons, nerves, and bones, which are at risk of necrosis if not adequately covered7. The extent of the injury can vary, with some cases involving only a small area, while others may affect a significant portion of the body surface area3.
Management Strategies
The management of degloving injuries requires a multidisciplinary approach and early intervention to minimize complications such as infection and tissue necrosis. Key management strategies include:
Initial Assessment and Stabilization
Early recognition and stabilization of the patient are crucial. This includes controlling bleeding, preventing shock, and assessing the extent of the injury2 4.
Surgical Intervention
Surgical management often involves debridement of non-viable tissues, drainage of hematomas, and reconstruction. Techniques such as skin grafting, flap coverage, and vacuum-assisted closure (VAC) therapy are commonly used5 6 8 9. In cases involving the hand and fingers, replantation of avulsed structures and the use of composite flaps may be necessary to restore function and aesthetics7 10.
Rehabilitation
Rehabilitation is an essential component of the recovery process. It involves physical therapy to restore mobility and function, as well as psychological support to help patients cope with the trauma2.
Outcomes and Prognosis
The prognosis of degloving injuries depends on the severity of the injury, the promptness of treatment, and the presence of underlying fractures. Injuries with underlying fractures are associated with poorer outcomes and longer hospital stays4. Early plastic surgery intervention and appropriate wound management can significantly improve outcomes and reduce the risk of complications4 5.