Avulsion wounds of the skin are typically a severe type of skin injury. These wounds often require surgery to repair. While the treatment and care of avulsion wounds will depend on how severe the wound is, all care should be done carefully.
What Is an Avulsion Wound?
An avulsion wound refers to a wound in which a part of the body has been torn off or removed through either surgery or trauma. There are many types of avulsion wounds, including:
- Avulsion fracture: Avulsion fractures, also called periosteal avulsions, happen when a chunk of bone that is attached to a ligament or tendon is pulled away from the rest of the bone.
- Brachial plexus avulsion: The brachial plexus is a group of nerves along the spinal cord and neck. In a brachial plexus avulsion, the root of the nerve is detached from the spinal cord.
- Ear avulsion: Ear avulsions happen when some or all of the outer part of the ear is separated from the head.
- Eyelid avulsion: Eyelid avulsions are the result of some or all of the eyelid being torn away. This can happen with either the top or bottom eyelid.
- Nail avulsion: In a nail avulsion, some or all of the nail is torn or removed from the nail bed. In some cases, this may be done surgically, such as to relieve chronic ingrown toenails.
- Surgical avulsion: A surgical avulsion is a situation in which a part of the body needs to be permanently removed.
- Tooth avulsion. Tooth avulsions refer to situations in which a tooth is completely removed from its socket, usually with the root still attached. This does not include baby teeth that fall out naturally.
The most common type of avulsion injury is a skin avulsion wound. Your skin is made up of three tissue layers. From outside in, they are the epidermis, the dermis, and the hypodermis. In a skin avulsion injury, all layers of skin are gone from the wounded area. With this type of injury, muscle, fat, or bone may be visible. Skin avulsion injuries are also sometimes referred to as “degloving” injuries.
Common examples of avulsion wounds include the tip of the finger or toe being cut or torn off. This can happen due to everyday activities, like using a knife to chop food or running and tripping in open-toed shoes.
Skin avulsions are often caused by trauma. This can include situations such as motor vehicle accidents, an athletic accident, a machinery accident, attack by an animal or human, or a fall from high up.
In some types of skin avulsion wounds, there is a flap of skin still attached. In other wounds, the skin is completely gone. Some professionals consider amputation to be a form of avulsion, but Occupational Safety and Health Administration differentiates between the two, specifying that avulsion involves tearing or separation of tissue, while amputation involves the loss of body parts or limbs.
Avulsion Wound Treatment
Injuries typically heal from the bottom up and from the edges in. In an avulsion, all layers of skin are removed, so there is no way for the injury to heal from the bottom up. It can only heal from the edges inward, and as a result may take some time to heal.
The treatment you need will depend on the severity of your injury. Smaller injuries can be treated at home, while more significant injuries will need medical care. The size and severity of your injury will determine what kind of treatment option your medical provider chooses.
Stitches. If your avulsion wound is deep but not too wide, your doctor may be able to close it up with stitches, also called sutures. To perform stitches, your doctor will use a sterile thread to bring the two sides of the wound together and sew it closed.
Reattaching skin. If there is still a skin flap attached to the wound, and the flap is healthy, your doctor may be able to reattach the skin into its original place. In order to do this, the skin flap must still have good blood flow. After the skin is stitched back into place, tubes will likely need to be used to remove excess fluid.
Skin graft. If there is no flap of skin available to reattach, your doctor may opt for a skin graft instead. A skin graft is done by taking a patch of healthy skin from one part of the body and transplanting it to the injured site.
Most skin grafts only take the top to layers of skin, leaving the hypodermis behind. This is called a split-thickness skin graft. If the area needing coverage is large, the donor skin can be cut into a mesh pattern to allow for more stretch.
How to treat an avulsion wound at home. If your avulsion wound is mild, you may be able to take care of it at home. Treatment for a mild skin avulsion wound is similar to other types of at-home wound treatments. To take care of a mild wound:
- Thoroughly rinse out any dirt or debris from the wound and clean the wound with soap and water.
- Apply petroleum jelly to the wound and cover with a bandage to prevent dirt and germs from entering the wound.
- Clean the wound daily using soap and water. After cleaning, reapply petroleum jelly and bandage.
- Avoid using antiseptics like hydrogen peroxide, as they may damage the skin and slow healing.
Avulsion Wound Healing and Care
The healing time for an avulsion wound will depend on the severity of the wound and the treatment needed to repair it.
The best way to speed along your recovery from an avulsion wound is to take proper care of your wound after you’re sent home. Always follow your doctor’s instructions for wound care. General care instructions for avulsion wounds include:
- Keep the wound clean and dry for about 24-48 hours.
- Change the dressing once a day or if it gets dirty or wet.
- After three days the bandage may be removed, except in the case of drainage.
- Clean the area gently but don’t wash or rub stitches or sutures directly.
- Don’t soak the injury in water until after sutures are removed or dissolved.
- When changing dressings, be very careful to avoid tearing delicate skin.
- Watch for signs of infection such as redness, swelling, and pus.
- Follow up with your provider if you notice signs of infection or if you develop a fever higher than 100.4ºF (38ºC).
