[libribook.com] Traumatic Scar Tissue Management 1st Edition

Degloving Injury
Degloving – named for the analogy of removing a glove – is a form of avulsion
injury in which an extensive portion of skin and subcutaneous tissue detaches
from the underlying fascia, and muscles or deeper tissues are avulsed from
underlying bone or other structures. Injury classification ranges from limited
avulsion with minimal tissue loss to circumferential multi-plane involvement of
muscle groups and periosteum. Degloving injuries can have a devastating
functional and aesthetic impact.
This type of injury typically occurs as a result of sudden shearing force trauma
(e.g. explosions, falls, blunt force trauma, fractures, vehicular accidents,
lacerations) and if mismanaged displays a high morbidity and mortality rate
(Wójcicki et al. 2011, Latifi 2013, Yan et al. 2013). Because this type of injury is
associated with violent or severe trauma, massive blood loss may occur.
While degloving injuries can occur in any region of the body, they occur more
frequently in the limbs, trunk, face and genitalia, with the lower limb being the
most common.
Degloving injuries are challenging to diagnose, with clinical assessment of the
degloved skin being a weak predictor of the extent of injury. Ultrasound,
computed tomography and MRI are indicated for proper diagnosis (Lafiti 2013).
Degloved skin that is totally avulsed from the patient’s body can be reattached
via a surgical procedure called replantation. This procedure requires great
expertise and vast resources. Concurrent life-threatening injuries may not allow
for a lengthy replantation and revascularization procedure (Lafiti 2013).
Because diagnosis can be delayed, degloving injuries are susceptible to
infections, delayed wound healing and necrotizing fasciitis (Dearden et al 2001,
Harold & Sadri 2013). Complications (e.g. multiple skin grafts, delayed wound
healing and infection), existing concomitant injuries, the mechanism and the
anatomy of the injury all factor into required treatment and prognosis (Latifi
2013).
Early recognition and diagnosis are key and a multidisciplinary approach is
desirable. Treatment requires careful assessment of the extent of the devitalized
tissue and the blood supply to the affected tissues. General treatment principles