Patterns and management of degloving injuries: a single national level 1 trauma center experience

Abstract

BackgroundDegloving soft tissue injuries (DSTIs) are serious surgical conditions. We aimed to evaluate the pattern, management and outcome of DSTIs in a single institute.MethodsA retrospective analysis was performed for patients admitted with DSTIs from 2011to 2013. Presentation, management and outcomes were analyzed according to the type of DSTI.ResultsOf 178 DSTI patients, 91 % were males with a mean age of 30.5 ± 12.8. Three-quarter of cases was due to traffic–related injuries. Eighty percent of open DSTI cases were identified. Primary debridement and closure (62.9 %) was the frequent intervention used. Intermediate closed drainage under ultrasound guidance was performed in 7 patients; however, recurrence occurred in 4 patients who underwent closed serial drainage for recollection and ended with a proper debridement with or without vacuum assisted closure (VAC). Closed DSTIs were mainly seen in the lower extremity and back region and initially treated with conservative management as compared to open DSTIs. Infection and skin necrosis were reported in 9 cases only. Open DSTIs were more likely involving head and neck region and being treated by primary debridement/suturing and serial debridement/washout with or without VAC. All-cause DSTI mortality was 9 % that was higher in the closed DSTIs (19.4 vs 6.3 %; p = 0.01).ConclusionThe incidence of DSTIs is 4 % among trauma admissions over 3 years, with a greater predilection to males and young population. DSTIs are mostly underestimated particularly in the closed type that are usually missed at the initial presentation and associated with poor outcomes. Treatment guidelines are not well established and therefore further studies are warranted.

Dermal regeneration template and vacuum sealing drainage for treatment of traumatic degloving injuries of upper extremity in a single‐stage procedure

“…However, a considerable proportion of degloving injuries extend to tendon and bone, and in such cases, flap reconstruction has always been an alternative but might be compromised by the variable success of flap viability and the donor site morbidity. In addition, unstable medical conditions such as polytrauma or co‐morbidities make some patients poor candidates for flap reconstruction …”

“…A degloving injury is not uncommon in the emergency department or department of orthopaedics, accounting for approximately 4% of total trauma injuries. 1 Over 80% of degloving injuries occur at traffic and industrial accidents; high-energy shearing force is the primary mechanism, with resultant avulsions or detachment of the skin and subcutaneous tissue from the underlying muscle and fascia. 2 Early diagnosis and treatment of these injuries is of prime importance in the prevention of infections, full-thickness necrosis of the avulsed skin and even limb amputations.…”

“…In addition, unstable medical conditions such as polytrauma or co-morbidities make some patients poor candidates for flap reconstruction. 1 Skin substitutes have been developed in recent decades to minimize donor site morbidity while optimizing a functional and aesthetic outcome. Integra (Integra LifeSciences, Inc., Plainsboro, NY, USA) was invented by Yannas and Burke 4 in 1980, and since then, various artificial dermis products such as AlloDerm (LifeCell Corporation, Branchburg, NJ, USA), 5 Dermagraft (Smith and Nephew, Largo, FL, USA), Terudermis (Olympus Terumo Biomaterials Corp., Tokyo, Japan), 6 Matriderm (MedSkin Solutions Dr. Suwelack AG, Billerbeck, Germany) 7 and Pelnac 8 have been successfully applied for the treatment of complex full-thickness wounds.…”

Effects of heparin and hyperbaric oxygenation on necrosis reduction in an animal model for degloving injuries

“…However, keeping an ischemic flap will cause skin necrosis and consequently the loss of an important graft donor area, generating the need for skin capture in other areas, adding morbidity to an already severely compromised patient. On the other hand, an aggressive approach, with early debridement, when ill indicated, imposes unnecessary sequelae to the patient 3 . In addition, it is very difficult to precisely define which areas are devascularized and which are viable.…”

Negative pressure wound therapy as a „bridge” forthe final reconstruction of tissue defect following adegloving injury of the forearm – a case report

“…Negative pressure wound therapy as a "bridge" for the final reconstruction of tissue defect following a degloving injury of the forearm -a case report Introduction D EGLOVING injuries are a form of traumatic avulsions of the soft tissue, in which an extensive portion of skin and subcutaneous tissue are detached from underlying structures. 1 Shearing tangential forces applied against the body disrupt the perforating vessels at the fascial level, which eventually leads to skin necrosis. Separation of skin and subcutaneous tissues from underlying muscle and fascia leads to the creation of a space allowing for the accumulation of fluid.…”