Degloving injuries with versus without underlying fracture in a sub-Saharan African tertiary hospital: a prospective observational study

Abstract

BackgroundDegloving injuries are surgical conditions in which an extensive portion of skin and subcutaneous tissue is detached from the underlying fasciae, muscles, or bone surface. Frequently, there is an association of fracture underlying the degloved area. We aimed to compare the short-term outcomes of degloving injuries with and without underlying fracture.MethodsA prospective cohort study was conducted. We recruited patients with degloving injuries, and followed them up for 30 days to assess the outcomes. We collected data on socio-demography, cause and mechanism of injury, presence of underlying fracture, presence of shock at admission, injury severity score, location and size of degloving injuries, their management, and short-term outcomes. There were two comparison groups of degloving injuries based on the presence or absence of underlying fracture. We analyzed the differences between the two groups by using Fisher exact test for categorical variables and Student’s t test for continuous variables; p values < 0.05 were considered to be significant. Risk ratio was calculated for the short-term outcomes.ResultsThere were 1.56% (n = 51) of degloving injuries among 3279 admitted trauma patients during the study period of 5 months; 1% (n = 33) with and 0.56% (n = 18) without underlying fracture. For the overall degloving injuries, male-female ratio was 2 and mean age was 28.8 years; they were caused by road traffic crashes in 84%, and resulted in shock at admission in 29%. In the group with underlying fracture, lower limbs were frequently affected in 45% (p = 0.0018); serial debridement and excision of the avulsed flap were the most performed surgical procedures in 22% (p = 0.0373) and 14% (p = 0.0425), respectively; this same group had 3.9 times increased risk of developing poor outcomes (mainly infections) after 30 days and longer hospital stay (26.52 ± 31.31 days, p = 0.0472).ConclusionDegloving injuries with underlying fracture are frequent in the lower limbs, and have increased risk of poor short-term outcomes and longer hospital stay. We recommend an early plastic surgery review at admission of patients with degloving injuries with underlying fracture to improve the flap viability and reduce the infection risk.Electronic supplementary materialThe online version of this article (10.1186/s13018-017-0706-9) contains supplementary material, which is available to authorized users.

Injuries after Forklift Trucks Accidents – Injury Patterns, Therapy and Outcome in the Context of the Statutory Accident Insurance

“…Also, within the framework of interdisciplinary cooperation, depressive episodes and chronic pain syndromes were diagnosed in many accident victims, requiring long-term contributive medical care by algesiological and psychiatric-neurological specialists. While it is true that these forms of complications are frequently unavoidable due to the complex injuries involved, in our view the further course of illness can be favourably impacted by early recognition of complications during regular follow-up treatment 28 , 29 , 30 , 31 .…”

“…Daneben wurden im Rahmen der interdisziplinären Zusammenarbeit bei vielen Verunfallten depressive Episoden und chronische Schmerzsyndrome diagnostiziert mit Notwendigkeit einer dauerhaften Mitbetreuung auf algesiologischem und psychiatrisch-neurologischem Fachgebiet. Zwar lassen sich diese Formen von Komplikationen aufgrund der komplexen Verletzungen häufig nicht vermeiden, allerdings kann der weitere Krankheitsverlauf aus unserer Sicht durch ein frühzeitiges Erkennen von Komplikationen während der regelmäßigen Nachsorge günstig beeinflusst werden 28 , 29 , 30 , 31 .…”

Reconstructive challenges in major degloving injuries

“…Degloving injuries are defined as the avulsion of soft tissue whereby an extensive portion of the skin and subcutaneous tissue are avulsed from the underlying fascia, muscles, or bone [3]. These injuries occur as a result of shearing forces being applied to the tissues and in the civilian population are most commonly seen as a result of high energy road traffic accidents [3]. The most common anatomical locations of degloving injuries are the extremities, particularly the lower limb, and truncal areas [4].…”

Outcomes of closed interlocking intramedullary nailing of the tibia without fluoroscopy in resource-limited settings: experience from two hospitals in Cameroon

“…Lower limb fractures are among the more common types of fractures in sub-Saharan African [ 1 , 2 ]. In Cameroon, fracture of the tibia is common among young adults, and is challenging for surgical teams because of the scarcity of resources to provide and optimally treatment to those patients, respecting international guidelines [ 3 ].…”