What Is A Degloving Injury?

The purpose of this article is to provide a clear and concise definition of a degloving injury and explore the subtypes of this injury along with their signs and symptoms. Hopefully, this will help broaden your recognition and understanding of degloving injuries so that in the event of encountering such an injury, you are able to seek help and timely treatment appropriately.

Introduction

A degloving injury is a severe, traumatic type of injury in which the top layers of skin and tissue are forcibly torn away from the underlying muscles, tendons, and bones.¹ The affected skin can either be entirely removed from the body or remain partially attached, hanging near the wound. 

Degloving injuries can also be referred to as ‘avulsions’. They can occur on any part of your body, but the most common areas affected are the legs, feet, face, hands and fingers.^2,3,4,5

Degloving injuries are typically caused by high-impact events, such as motorbike or machinery accidents, falls from heights, post-burn injuries, or tumour excisions.^1,6,7 Additionally, elderly people are at greater risk of degloving injuries due to their increased likelihood of falls with increasing age, their thinning skin, and also age-related delayed wound healing.²

Understanding degloving injuries is important as they are often life-threatening and, therefore, require immediate medical attention. Early intervention is vital to minimise tissue damage, limit blood loss, reduce the risk of infection (including sepsis), and improve treatment and health outcomes.^4,8,9

Types of degloving injuries

There are two main types of degloving injuries – open degloving and closed degloving.

Open degloving

Open degloving occurs when the skin or subcutaneous tissue (tissue situated under the skin) is torn away from the underlying structures, exposing muscles, tendons, bones, or other tissues.¹⁰ This type of degloving injury typically involves a visible wound or laceration (a deep cut or tear in the flesh) where the skin has separated.  

Open degloving injuries are usually a result of high-impact incidents, such as vehicular accidents, falls from heights, industrial machinery accidents, or powerful animal bites.¹⁰

Open degloving injuries tend to be more severe than closed and have a higher risk of complications. Because the exposed underlying structures are susceptible to infection and contamination, it is essential to seek prompt medical attention.

Closed degloving

A closed degloving injury – also known as a Morel-Lavallee lesion – occurs when the top layer of skin remains intact, but there is detachment of the soft tissue from the underlying structures beneath the skin.¹¹ Unlike open degloving injuries, there may not be a visible external wound or laceration.

In common with open degloving injuries, closed degloving injuries can be caused by various accidents. Some examples include crush injuries, industrial accidents, and sports-related trauma (from activities such as skiing and biking). 

Closed degloving injuries are not common. Because the skin often remains intact, the superficial appearance of this type of degloving injury can be deceptive. This makes it difficult to immediately appreciate the extent of the soft tissue damage involved, which can also result in a misdiagnosis and insufficient treatment. 

Imaging studies may be required during diagnosis so that the extent of the injury can be assessed. 

Although degloving injuries are generally less severe than open ones, they still require medical attention and can lead to further complications such as haemorrhagic shock, soft tissue infection, or wound dehiscence (where a wound that has been repaired comes apart again).^12,13,14

Individuals with this type of injury can present with pain, changeable areas of swelling associated with ecchymosis (skin discolouration/bruising), skin firmness, and the skin having the capacity to be stretched beyond its normal range.¹⁵

Treatment options

Treatment options for degloving injuries can vary according to the severity and extent of the injury. Additionally, the treatment options available depend on the availability of specialist hospital resources. Not all emergency services are equipped to manage and tend to complex cases of skin repair; you may have to be transferred to a trauma centre or a surgical intensive care unit to receive advanced treatment.¹⁶

The separation of tissues from one another can lead to a loss of their blood supply and debilitating wounds. The prognosis of a degloved injury depends on its location on the body, the degree of tissue loss, and whether co-existing injuries are present. If mismanaged, degloving injuries are associated with high morbidity and mortality rates.^6,17

Degloved wounds can suffer protein loss and the rapid growth of bacteria, therefore it is vital to regain tissue coverage as soon as possible. Temporary coverage (for example, with biological bandaging) may prevent these issues from occurring; however, this injury requires autologous grafts (skin of the same tissue) for complete recovery, which is not always possible if the damage is extensive.¹⁸

Wound care/debridement

The first step in treating a degloving injury is the preparation of the wound bed. Degloving injuries are typically open wounds; they can be heavily contaminated and will need intense irrigation (the washing out of a wound with water or medication), debridement, and removal of non-functioning tissue.¹⁹

Surgery

Surgical treatment is typically required for moderate to severe degloving injuries. The specific surgical procedures that may be involved are outlined in the table below.^9,19,20

Moreover, this type of injury can often pose challenges for surgeons, particularly when complications arise, such as wound infections or necrosis (the decaying of cells) in the avulsed (loose) flap.²¹

Antibiotics

Antibiotics are generally used to prevent wound infection in degloving injuries, and smear test monitoring is required to check for gas gangrene.¹⁹

Amputation

Amputation may be considered in severe cases of degloving injuries where the damage to the injured area is extensive, not reparable, or if there is a risk of further health risks such as severe infections.²²

Physical therapy

Following surgery, patients frequently require rehabilitation and physiotherapy.

Physical therapy – otherwise known as physiotherapy – aims to help people who have been or are suffering from an injury, disability, or illness regain movement and function. Physical therapy support is likely necessary in the recovery process of a degloving injury. There are multiple critical roles that the physical therapist can serve in the injury rehabilitation phase. Some of these include:

• If amputation is required, physiotherapy can assist someone in developing use and trust of their prosthetic
• Physical therapy can help people restore function in an injured body part
• Physical therapy can help people regain mobility, flexibility, and a range of motion
• A physical therapist can also help people control pain or discomfort in their injured area

Psychological support

It can be emotionally challenging to suffer from and deal with a debilitating injury. Therefore, patients and their loved ones may benefit from psychological support, which can be tailored to each individual’s needs. Psychological support can hopefully help affected individuals manage the emotional and mental impacts of the injury, which can include coping with newfound scarring and changes to their quality of life.¹⁸  

Follow-up care

Regular follow-up appointments with healthcare providers are crucial in order to monitor the healing process, quickly identify the presence of any complications, and assess the need for additional treatments.²³

FAQs

How do degloving injuries happen?

Degloving injuries occur when the top layers of your skin and tissue are separated from the underlying muscle, connective tissue, and/or bone. It can affect any part of the body. It typically happens when the skin is caught in machinery or in high-speed accidents that result in the skin being pulled off of the underlying body structure.

What is the treatment for degloving injuries?

As degloving injuries are, by nature, severe, they require major surgical interventions and wound care. Here is a list of treatment component options potentially included in treatment plans for degloving injuries:

• Replantation or revascularisation of the degloved skin
• Skin grafts or skin flaps
• Reconstructive surgeries
• Amputations
• Reattachments of fingers, toes, and facial features
• Tissue debridement
• IV fluids and antibiotics
• Physical therapy (physiotherapy)

Can you recover from a degloving injury?

Yes, it is possible to recover from a degloving injury. However, the extent of recovery is dependent on several factors, including the severity of the injury, how immediately you seek medical aid, and the type of treatment your injury will require.

What are the different types of degloving injuries?

Degloving injuries are typically categorised into two classes: open degloving and closed degloving. The category into which a degloved injury falls depends on whether the overlying skin is intact or has been torn away from the underlying tissue. 

Summary

A degloving injury is severe and traumatic and involves the removal of the skin and underlying tissue (be it wholly or partially) from the underlying structures comprised of muscles, bones, tendons, blood vessels, and nerves. Degloving injuries can typically be classified into two types – open and closed – and each one presents its own unique challenges for management. Treatment for degloving injuries usually involves urgent medical attention, surgical intervention, wound care, rehabilitation, and, potentially, psychological support. The recovery outcome is dependent on multiple factors, such as the injury’s severity, promptness of treatment, rehabilitation efforts, and individual factors.