Degloving

Finger degloving and amputation

Degloving occurs when skin and the fat below it, the subcutaneous tissue, are torn away from the underlying anatomical structures they are normally attached to.[1] Normally the subcutaneous tissue layer is attached to the fibrous layer that covers muscles known as deep fascia.[1]

A degloving injury is a type of soft-tissue avulsion injury that can occur anywhere in the body.[1] Commonly affected areas include the face, scalp, trunk, limbs, and genitalia.[1] Degloving injuries are caused by shearing forces that cause the soft tissue layers to get pulled apart.[1][2] They were first reported in the twentieth century from machinery such as a wringers used to dry clothes.[3] The invention and widespread use of automobiles also lead to degloving and other traumatic injuries.[3]

Degloving injuries can be categorized as either open or closed.[1] Closed injuries are not open to the external world and the underlying structures are not visible. In open injuries, the skin is torn back so that the underlying structures are visible. Such an injury could thus resemble the process of removing a glove from a hand.

The treatment of a degloving injury requires assessment of the damage to the soft tissue and associated blood vessels.[1] Any soft tissue that is dead must be removed.[1][2] If the soft tissue that was torn away is healthy and has a blood supply, it can be used in the treatment.[1] Replantation and revascularization are when the soft tissue that was torn away is reattached with proper blood flow.[1] In cases where reattachment can’t occur, skin flaps or skin grafting may be done.[1]

  1. ^ a b c d e f g h i j k Latifi, Rifat; El-Hennawy, Hany; El-Menyar, Ayman; Peralta, Ruben; Asim, Mohammad; Consunji, Rafael; Al-Thani, Hassan (2014). "The therapeutic challenges of degloving soft-tissue injuries". Journal of Emergencies, Trauma, and Shock. 7 (3): 228–232. doi:10.4103/0974-2700.136870. ISSN 0974-2700. PMC 4126125. PMID 25114435.
  2. ^ a b Eccles, Simon; Handley, Bob; Khan, Umraz; McFadyen, Iain; Nanchahal, Jagdeep; Nayagam, Selvadurai, eds. (2020). "Degloving Injuries". Standards for the Management of Open Fractures. pp. 25–30. doi:10.1093/med/9780198849360.003.0004. ISBN 978-0198849360.
  3. ^ a b Lekuya, Hervé Monka; Alenyo, Rose; Kajja, Isaac; Bangirana, Alexander; Mbiine, Ronald; Deng, Ater Ngoth; Galukande, Moses (5 January 2018). "Degloving injuries with versus without underlying fracture in a sub-Saharan African tertiary hospital: a prospective observational study". Journal of Orthopaedic Surgery and Research. 13 (1): 2. doi:10.1186/s13018-017-0706-9. ISSN 1749-799X. PMC 5756448. PMID 29304820.