What is degloving?
Degloving, also called avulsion, is a type of severe injury that happens when the top layers of your skin and tissue are ripped from the underlying muscle, connective tissue, or bone. It can affect any body part, but it’s more common in the legs. Degloving injuries are often life-threatening. This is because they involve large amounts of blood loss and tissue death.
Keep reading to learn more about this type of injury and how it’s treated.
Are there different types of degloving?
There are two main types of degloving. They’re known as open degloving and closed degloving.
When your skin and tissue is ripped away — exposing muscle, bone, or connective tissue — it’s known as open degloving. In some cases, the skin might still be partially attached as a flap near the wound.
Open degloving injuries are usually caused by:
- traffic accidents
- accidents with industrial or farm equipment
- falls from heights
- sports injuries
- animal bites
The most common areas for open degloving injuries are the:
However, they can affect any body part, including the fingers, arms, or feet.
Open degloving injuries are serious. They require emergency care to reduce blood loss and prevent infection.
Closed degloving injuries aren’t always visible. This makes them harder for doctors to diagnose. In some cases, they can cause a bruise, but this is usually the only visible symptom. A 2017 review estimated that up to one-third of people with closed degloving injuries may have a delayed diagnosis.
Many closed degloving injuries involve a force that separates the top layer of skin and tissue from deeper tissues, leaving a space under the skin. These spaces are known as Morel-Lavallée lesions. The lesions can fill with lymph fluid, blood, and fat.
Despite their different appearance, closed degloving injuries are caused by the same types of accidents that lead to open degloving injuries.
Closed degloving injuries are most common at the top of the hip bone in an area called the greater trochanter. About 60 percent of these injuries involve the greater trochanter, according to the 2017 review. Other common areas include the:
- lower spine
- shoulder blades
Most doctors diagnose closed degloving injuries using an MRI scan, which can detect Morel-Lavallée lesions.
How is it treated?
Treatment for degloving injuries depends on the type, severity, and location of the injury. They’re also often accompanied by other serious injuries, such as broken bones, that require emergency treatment.
The availability of advanced trauma treatment is also a factor. Not all emergency centers may have the expertise for complex skin repair.
Open degloving injuries
Treating open degloving injuries depends on both the extent of the injury and hospital resources. Not all emergency rooms are equipped to handle complex skin repair. You may need to be transferred to a nearby trauma center for more advanced treatment.
Depending on the amount of skin left and the type of injury, treatment options include:
- reattaching the skin
- skin grafts using skin from other parts of the body
- reattachment of a finger or toe
All of these options usually require multiple surgeries. You may need to stay in the hospital for days or weeks, depending on the injury. You may also need to follow up with physical therapy to regain use of the injured body part.
In some cases, a small degloving injury will only need a thorough cleaning and some bandaging to help it heal.
Treating closed degloving injuries also depends on the extent of the injury. For more minor cases, you may just need a combination of compression bandages, physical therapy, and rest.
For more severe cases, treatment options include:
- draining any built-up fluid from the lesion
- removing dead tissue
- sclerotherapy, which involves injecting blood vessels with medication to make them shrink
Are there any complications?
Degloving injuries are very serious on their own, but they also carry a big risk of infection since they’re often very deep wounds. To minimize your risk, make sure you seek emergency medical treatment so the wound is thoroughly cleaned. As you recover, make sure to tell you doctor if you have any of the following symptoms:
- red-colored edges surrounding the wound
- swelling of the wound
- oozing around the wound, especially if it’s yellow or smells bad
- body aches
Untreated closed degloving injuries can also lead to severe tissue death.
What’s the outlook?
Degloving injuries are serious and sometimes fatal. Early treatment is key to prevent infections. Treatment usually requires an extended stay at the hospital and several surgeries, followed by several months of physical therapy.