What Is Degloving?
SDI Productions / Getty Images
Medically reviewed by Josephine Hessert, DO
Degloving injuries, also known as avulsion or degloving soft tissue injuries (DSTIs), occur when extensive portions of skin and subcutaneous tissue (soft tissue) are forcefully torn away from the underlying muscle and fascia (connective tissue). This can lead to severe blood loss and necrosis (cell death) of the affected tissue.
Degloving is a serious traumatic injury that can sometimes be fatal. It typically requires early surgical treatment to save the affected limb or other tissue.
Types of Degloving Injuries
Degloving injuries are typically classified as open or closed.
Open (External) Degloving
Open, or external, degloving is visible to the naked eye. It occurs when several layers of skin and underlying soft tissue are torn off “like a glove,” leaving the muscles, fascia, and sometimes bone exposed. A flap of skin may or may not still be connected, but the blood supply to the area is cut off.
Open degloving injuries can occur anywhere on the body, but they are most common on the:
Extremities (hands, feet, fingers, legs, and arms)
Abdomen
Chest
Head
Face
Closed (Internal) Degloving
Closed, or internal, degloving may not be as evident right away. Injuries may resemble bruises, often leading to a delay in diagnosis.
In many cases, closed degloving injuries lead to Morel-Lavallée lesions. These are internal wounds caused by the forceful tearing away of skin and fat from deeper layers of muscle and connective tissue. The spaces may fill up with blood, lymphatic fluid, fat, and debris, leading to swelling and sometimes infection over time.
Most Morel-Lavallée lesions occur at the following sites:
Greater trochanter (top of the hip)
Buttocks
Back
Pelvis
Genitalia
Knees
Abdomen
Thighs
Symptoms of Degloving
Degloving injuries are extremely painful. In addition to pain, symptoms of open degloving injuries may include:
Large wound with exposed muscle and sometimes bone
Partial or full detachment of a large area of skin and underlying tissue
Hemorrhage (extreme blood loss)
Shock
Hypotension (low blood pressure)
Closed degloving injuries are also painful, but they may not be as obvious at first glance. Symptoms of an internal degloving injury may include:
Deep bruising
Dried, cracked skin
Swelling and inflammation
Skin discoloration due to necrosis
Inability to use or feel the affected area
You may experience other injuries along with degloving, such as:
Bone fractures
Blood vessel damage
Related: What Is Whiplash?
What Causes Degloving Injuries?
Degloving injuries are typically caused by blunt force trauma, including crushing, collisions, knocking, falling, trampling, or forceful pulling. The vast majority of degloving injuries are caused by a car or motorcycle accident—whether as a driver, passenger, or pedestrian.
Other causes of degloving injuries include:
Falls from extreme heights
Accidents involving heavy machinery, such as farm or factory equipment
Sports-related injuries
Animal attacks
Complications from surgery, such as liposuction
Estimates suggest that up to 91% of people who experience degloving injuries are people who identify as male, perhaps because they're more likely to serve in high-risk occupations such as tree-cutting, agricultural labor, and factory work.
How Are Degloving Injuries Diagnosed?
Open degloving injuries are typically diagnosed in a trauma center or emergency room. In addition to a physical examination of your wounds and bleeding, your healthcare provider may assess the color, temperature, and responsiveness of your skin to determine whether or not you’ve experienced a degloving injury. Blood tests and blood pressure measurements can help to determine the extent of your blood loss.
About 33% of people with internal (closed) degloving injuries are not diagnosed right away. Instead, you may notice ongoing bruises, pain, and swelling in the affected area over time.
Imaging tests are typically used to diagnose Morel-Lavallée lesions. These tests include:
Magnetic resonance imaging (MRI) scan: A procedure that uses a strong magnetic field and radio waves to generate images of the body
Computerized tomography (CT) scan: A procedure that uses a specialized device that rotates around your body and creates a series of X-ray images
Ultrasound: A technology that produces high-frequency sound waves to generate images
How Are Degloving Injuries Treated?
Degloving treatment depends on the type, location, and severity of the injury.
More minor degloving injuries might be treated with compression bandages and possibly aspiration (removing fluid with a needle).
Most degloving injuries are treated with surgery—either to close the wound and restore function or to reconstruct the affected area. Your healthcare provider or a surgeon may recommend any of the following procedures, depending on where you were injured and the extent of the damage:
Vacuum-assisted wound closure (wound VAC): Using a device to decrease pressure on the wound, which helps it heal
Preparing necrotic (dead) tissue for surgery: Might include debridement (cleaning and removing), excision (removing with a sharp instrument), or draining fluid
Replantation: Reattachment of the removed skin, if enough has been preserved
Revascularization: A procedure to restore blood flow to the affected area
Skin grafts or flaps: Using skin from another part of your body to replace skin lost by degloving
You may also be prescribed antibiotics to prevent or treat infection or require a blood transfusion if you experience severe blood loss (often from associated injuries).
If too much of the tissue has lost function, the affected limb may need to be amputated.
Post-surgery recovery might take weeks, months, or longer. It’s important to follow your healthcare provider’s instructions on dressing and cleaning your wound. You may need to visit your healthcare provider for multiple surgeries or follow-ups to speed up the wound-healing process and prevent pressure sores and other complications.
Related: Here’s How To Tell if You Have an Infected Cut—and What To Do About It
Possible Complications of Degloving
Outside of the injuries themselves, degloving can lead to complications like:
Severe blood loss
Shock
Infection
Sepsis (a whole-body inflammatory response that requires emergency medical treatment)
Necrosis (tissue death)
Whether you have a closed or open degloving injury, watch for any signs of a skin infection, including:
Pain or tenderness
Redness or discoloration
Skin that is warm to the touch
Drainage of pus or other fluids
Swelling
Certain risk factors may increase your chance of developing an infection or other complications. Risk factors include:
Diabetes (a chronic disease that occurs when you have higher than normal levels of blood glucose, or blood sugar)
Hypertension (high blood pressure)
Coronary artery disease, or CAD (a type of heart disease that occurs when the blood vessels, or arteries, that feed your heart become narrow)
Smoking
When to Contact a Healthcare Provider
Degloving is a medical emergency and can be life-threatening. If you or someone you know has experienced a traumatic injury, call 911 or go to the hospital immediately. It’s especially important to watch for signs of shock, such as:
Confusion
Fainting
Excessive sweating
Weak pulse
Hypotension
Clammy extremities
Hyperventilation
Pale or discolored skin
Also contact a healthcare provider if you notice any signs of a closed degloving injury, such as pain, swelling, numbness, or bruises in a certain area. These may be symptoms of a superficial injury, but it’s important to contact a clinician if they don’t resolve on their own.
A Quick Review
Degloving injuries occur when the topmost layers of skin and subcutaneous tissue are forcefully ripped away from the muscle and fascia underneath. This most commonly happens due to a motor vehicle accident, but other blunt force trauma can cause it.
Degloving injuries can be either open (external) or closed (internal) and often occur on the face, trunk, head, limbs, pelvis, or genitalia. Both open and closed degloving injuries are typically treated through surgical reconstruction.
A degloving injury is a serious medical emergency that requires prompt attention. If left untreated, it can cause infection, necrosis, or even amputation.
For more Health.com news, make sure to sign up for our newsletter!
Read the original article on Health.com.
