Do you know what degloving injuries are? They are a type of severe injury that happens when the top layers of skin and tissue are ripped from the underlying muscle, connective tissue, or bone. They can affect any body part but are more common in the legs. They are often life-threatening due to blood loss and infection risk.
Degloving injuries are rare but can have serious consequences, especially if they are not detected or treated promptly. They are usually caused by high-energy trauma, such as traffic accidents, industrial or farm equipment accidents, falls from heights, sports injuries, or animal bites. They often occur along with other serious injuries, such as fractures or internal bleeding.
In this article, we will explain the types, causes, remedies, and complications of degloving injuries. We will also give you some tips and recommendations for the prevention and management of these injuries.
Types of Degloving Injuries
There are two main types of degloving injuries – open and closed. They have different characteristics, degloving causes, areas affected, and diagnoses.
Open degloving injuries are those that expose the underlying tissues, such as muscle, bone, or connective tissue. The skin and tissue may be completely torn off or partially attached as a flap near the wound. Open degloving injuries are usually caused by the same factors that lead to closed degloving injuries. The most common areas for open degloving injuries are the legs, torso, scalp, face (e.g., degloved face), fingers (e.g., degloved hand), arms, or feet. Open degloving injuries are serious and require emergency care to reduce blood loss and prevent infection. They can be diagnosed by clinical examination.
Closed degloving injuries are those that create a potential space under the skin filled with fluid. The fluid may contain blood, lymph, and fat. The skin surface may look bruised or normal. Closed degloving injuries are also caused by high-energy trauma that separates the superficial fascia from the deep fascia in a shearing mechanism. The most common areas for closed degloving injuries are the greater trochanter/hip, thigh, pelvis, knee, gluteal region, lumbosacral area, shoulder blades, abdominal area, and calf/lower leg. Closed degloving injuries are harder to diagnose and may have delayed presentation. They can be detected by MRI scans.
The table below shows the differences between open and closed degloving injuries.
| Type | Appearance | Causes | Areas Affected | Diagnosis |
| Open | Skin and tissue are ripped away, exposing underlying tissues | Traffic accidents, industrial or farm equipment accidents, falls from heights, sports injuries, animal bites | Legs, torso, scalp, face (e.g., degloved face), fingers (e.g., degloved hand), arms, feet | Clinical examination |
| Closed | Bruise or no visible sign on the skin surface | Same as open degloving injuries | Greater trochanter/hip, thigh, pelvis, knee, gluteal region, lumbosacral area, shoulder blades, abdominal area, calf/lower leg | MRI scan |
Remedies for Degloving Injuries
Treatment for degloving injuries depends on the type, severity, and location of the injury. They also depend on the availability of advanced trauma treatment and the presence of other associated injuries. The general principles of treatment are to stop bleeding, prevent infection, debride necrotic tissue, restore blood supply, and reconstruct skin and soft tissue.
The specific treatment options for open degloving injuries include:
- Primary closure: This involves suturing the wound edges together if there is enough viable skin and tissue.
- Skin grafts or flaps: This involves transferring skin from another part of the body or using local or distant flaps to cover the wound.
- Negative pressure wound therapy (NPWT): This involves applying a vacuum device to the wound to promote healing and reduce infection.
- Free tissue transfer: This involves transplanting skin, muscle, or bone from another part of the body along with blood vessels to reconstruct the wound.
The specific treatment options for closed degloving injuries include:
- Aspiration: This involves using a needle or syringe to remove the fluid from the potential space under the skin.
- Drainage: This involves inserting a tube or catheter into the potential space to drain the fluid continuously.
- Sclerotherapy: This involves injecting a chemical agent into the potential space to cause inflammation and scarring that closes the space.
- NPWT: This involves applying a vacuum device to the wound to promote healing and reduce infection.
- Surgical excision: This involves removing the potential space surgically and closing the wound.
The list below summarises the treatment options for each type of degloving injury.
1. Open degloving Injuries
- Primary closure
- Skin grafts or flaps
- NPWT
- Free tissue transfer
2. Closed Degloving Injuries
- Aspiration
- Drainage
- Sclerotherapy
- NPWT
- Surgical excision
Complications of Degloving Injuries
Degloving injuries can have serious short-term and long-term complications. They can affect the function and appearance of the affected body part and the quality of life of the patient.
Some common short-term complications are:
- Haemorrhage: This involves excessive bleeding from the wound or the underlying tissues.
- Infection: This involves bacterial invasion of the wound or the potential space, leading to inflammation, pus formation, and systemic symptoms.
- Sepsis: This involves a life-threatening condition where the infection spreads to the bloodstream and causes organ failure.
- Compartment syndrome: This involves increased pressure within a closed space of muscle and tissue, leading to reduced blood flow and nerve damage.
- Osteomyelitis: This involves infection of the bone, leading to pain, swelling, and bone destruction.
Some common long-term complications are:
- Chronic pain: This involves persistent or recurrent pain in the affected area that interferes with daily activities.
- Scarring: This involves abnormal healing of the wound that results in thick, raised, or discoloured skin.
- Contractures: This involves tightening or shortening of the skin, muscle, or connective tissue that limits the range of motion of the affected joint.
- Lymphedema: This involves swelling of the affected limb due to impaired lymphatic drainage.
- Nerve damage: This involves injury to the nerves that supply sensation or movement to the affected area, leading to numbness, tingling, weakness, or paralysis.
The list below summarises the complications of degloving injuries.
1. Short-Term Complications
- Haemorrhage
- Infection
- Sepsis
- Compartment syndrome
- Osteomyelitis
2. Long-Term Complications
- Chronic pain
- Scarring
- Contractures
- Lymphedema
- Nerve damage
Conclusion
We have explained degloving injuries, a type of severe injury that rips the skin and tissue from the underlying structures. They can affect any body part but are more common in the legs. They are often life-threatening and require emergency care.
They have two types – open and closed. They have different appearances, degloving causes, and treatments. They can also have serious complications, both short-term and long-term. To prevent them, follow safety measures. To manage them, seek medical attention, follow wound care, take antibiotics, and undergo therapy.
