Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management

Abstract

Background: We aimed to identify degloving soft tissue injury (DSTI) patient characteristics, injury and reconstruction patterns, and factors affecting outcomes of DSTI injuries to propose a reconstructive protocol for these injuries. Methods: A retrospective analysis of consecutive patients with DSTIs of an extremity over a 22-year period has been done. Results: 188 patients with 201 extremity DSTIs were included. Mean patient age was 37 years, with follow-up of 19.6 months. In total, 96% of injuries were related to motor vehicles or machinery, and 74.6% of DSTIs had injuries to structures deep to skin/subcutis. The avulsed tissue was utilized in reconstruction in 71.6% of cases and 86.8% of these experienced some loss of the used avulsed tissues. Of the total cases, 82% employed skin grafting in reconstruction. Dermal regeneration templates were used in 32% of patients. An estimated 86.5% of patients had negative pressure wound therapy utilized. Of the injured patients, 21% required flap reconstruction and 22% required some form of amputation. Age, body mass index, and tobacco use did not increase perioperative complications or amputation. DSTIs with injury to structures deep to skin/subcutis were associated with negative pressure wound therapy use ( P = 0.02). DSTIs with underlying fractures required more procedures to reach reconstruction completion ( P = 0.008), had more minor ( P = 0.49) and major perioperative complications ( P = 0.001), longer time to heal ( P = 0.002), and increased need for amputation ( P = 0.02). Conclusions: Factors affecting the reconstructive management and outcome of DSTIs include injury to structures deep to the skin/subcutis. We categorized DSTIs based on the level of injury and proposed a systematic approach to extremity DSTIs which may be utilized by plastic surgeons and other surgical services to manage these complex injuries.

NovoSorb Biodegradable Temporizing Matrix for Reconstruction of Multiplanar Degloving Injury of the Upper Limb

“…To date, published case series have described local flaps and free tissue transfer for coverage of wounds that involve exposed vital structures such as nerves, vessels, and tendons. 2 NovoSorb biodegradable temporizing matrix (BTM; PolyNovo Biomaterials Pty Ltd, Melbourne, Australia) is a bilayer bioabsorbable synthetic polymer dermal substitute, which has the ability to integrate into large wound beds and is resistant to infection. 3 BTM comprises a bioabsorbable, polyurethane matrix that allows for cellular infiltration and a temporary nonbiodegradable, nonporous polyurethane layer, which limits moisture loss and provides a barrier to bacteria.…”

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries

“…1 These limb-threatening injuries are difficult to treat, can lead to loss of function, and may be complicated by infection; thus, they frequently receive multidisciplinary care. 2 Options for intervention include serial debridement, skin grafting, skin substitute use, negative-pressure wound therapy (NPWT), revascularization/replantation, flap reconstruction, and amputation in the most extensive cases. 2 Research has previously described a "weekend effect," referring to the higher risk of morbidity and death for patients admitted to hospitals on weekends.…”

“…2 Options for intervention include serial debridement, skin grafting, skin substitute use, negative-pressure wound therapy (NPWT), revascularization/replantation, flap reconstruction, and amputation in the most extensive cases. 2 Research has previously described a "weekend effect," referring to the higher risk of morbidity and death for patients admitted to hospitals on weekends. 3,4 Weekend presentation has also been shown to increase length of stay, increase risk of readmission, and decrease likelihood of operative intervention across conditions, including stroke, heart failure, and myocardial infarction.…”

“… 2 Options for intervention include serial debridement, skin grafting, skin substitute use, negative-pressure wound therapy (NPWT), revascularization/replantation, flap reconstruction, and amputation in the most extensive cases. 2 …”

Surgical Treatment of Finger Degloving Injuries Without Usable Skin: a Case Report and Literature Review

“…These injuries can affect any part of the body, but the lower limbs, face and neck, back and upper limbs are the most commonly affected [1]. DSTI often involves concomitant damage to deeper anatomical structures, most commonly nerves, blood vessels, bones and tendons [2]. The main principles of treatment of DSTI are rapid diagnosis, excision of non-viable tissue, skeletal fixation if fractures are present, and replantation of the amputated body part.…”