Degloving, also known as avulsion, happens when a large piece of your skin along with the layer of soft tissue right under it is partially or completely ripped from your muscles and connecting tissues. These layers of skin stop getting blood even if they're still attached as a skin flap.
Often, degloving injuries are very serious. If you have one, there won’t be much doubt in your mind about what’s happened: your skin will be stripped back from the injured area like a glove.
Degloving injuries can be superficial (on the top of your skin) or dangerously deep below the layers of your skin. Depending on how bad your injury is, you may have serious long-term effects. When your skin is degloved, you need medical treatment immediately.
Types of Degloving Injuries
There are two main types of degloving injuries, open and closed.
Open degloving
Open, or external, degloving is more obvious and graphic. It happens when a section of your skin and tissue is ripped away, leaving your muscles, tendons, connective tissue, and sometimes bones underneath exposed. Your skin may be completely removed from your body or partially attached and hanging on as a flap. These injuries can happen anywhere on your body but are most often seen on the legs, torso, and scalp.
Closed degloving
Closed, or internal, degloving injuries tend to be harder to diagnose than open ones because they're less obvious and graphic. They're internal wounds that happen when your skin and fat are ripped apart from deep layers of muscle and connective tissue. Your top layers of skin usually show no major signs of injury other than maybe some bruising. Closed degloving injuries are sometimes called Morel-Lavallée lesions.
Closed degloving injuries create deep cavities under your skin that can fill with blood, lymph fluid, and liquefied fat, making the surface of your skin look swollen. These injuries might not even become obvious until the separated tissue starts to die and your skin turns purple or black. Closed degloving injuries usually happen at the top of your hipbone and, less often, on your torso, buttocks, lower spine, shoulder blades, and knees.
Symptoms of Degloving
Your symptoms will depend on whether you have a closed or open degloving injury and how severe it is.
Common symptoms of open degloving injuries include:
- Extreme pain
- Deep lacerations or open wounds
- Exposed bone, muscle, tendons, nerves, and/or connective tissue
- Severe blood loss
- Total or partial skin separation
- Tissue death
- Shock
Symptoms of closed degloving injuries include:
- Pain
- Bruising and skin discoloration
- Swelling
- Tenderness
- Dry, cracked skin
How painful is a degloving injury?
Pain is definitely a symptom of both open and closed degloving injuries, but how bad it is will depend on how serious your degloving injury is. You can expect extreme pain with a wide-open and exposed degloving injury. But if it's a minor, closed degloving case, your pain may feel more like tenderness or bruising.
What Causes Degloving?
Any part of your body covered by skin can become degloved. It happens when you're involved in some kind of high-energy accident, like if your long hair gets caught in a conveyor belt. The conveyor belt would violently rip your skin and soft tissue away from your skull and its underlying muscle and tissue. This is one example of how you could end up with a completely degloved face injury, but the injuries happen most often to the hands, feet, legs, and arms.
Another example is if a tire runs over your foot. The intense pressure of the tire, combined with some sort of motion (you pulling your foot out from under the tire or the tire dragging over your foot) could peel your skin and soft tissue off, leaving you with a degloved foot.
Degloving injuries are usually caused by:
- Car, cycling, or motorcycle accidents
- Incidents involving heavy machinery such as farm equipment or conveyor belts
- Falls from high heights
- Sports injuries
- Animal bites or attacks
- Rings getting ripped from fingers
Treating a Degloving Injury
Because of the wide range of possible degloving injuries, there are numerous treatment options. What your doctor chooses will depend on how serious your wound is. The treatment process itself is generally very complicated and requires health professionals to make important decisions in a short period. The first priority is to save as much of your skin as possible. Less severe injuries can be fixed with skin grafts or skin flaps, but if your injury is more serious, you might need reconstructive surgery or even amputation.
Treatment options for open degloving
- Reattaching the degloved skin
- Using a skin graft (skin from another part of the body) to cover exposed flesh
- Reattachment of fingers or toes
- Amputation
Treatment options for closed degloving
- Compression bandages
- Physical therapy
- Draining of fluid in the wound
- Removal of dead tissue
- Injections in enlarged blood vessels to help them shrink
Skin graft vs. skin flap
Skin grafts and skin flaps are both used in reconstructive surgeries to treat degloving injuries. The goal is to make your injury look as normal as possible again by placing new skin over your wound.
The main difference between a skin graft and a skin flap is the blood supply. Doctors can try to reattach the skin flap that is still connected to your body, keeping the blood supply intact.
If that's not an option, your surgeon might be able to create a skin graft out of the skin flap and stitch it into its original place. Because it's made out of the degloved skin flap, the new skin graft is removed from its blood supply.
If you lose too much blood or if your degloving injury is very deep, your life could be at risk. The earlier your injury is treated, the better your outcome.
Degloving Complications
If you have a degloving injury, you could expect various long-term effects depending on how serious your injury is. You’ll likely have a scar or some trace of your injury. You may face a long healing process that requires physical therapy and rehabilitation, plus regular aftercare from your doctor. You may even lose the function of the body part you injured.
Early treatment is important for degloving injuries. But even with that, you can still have complications. Some long-term effects of degloving injuries include:
- Infection
- Compartment syndrome (painful pressure buildup in your muscles)
- Osteomyelitis (infection of your bone)
- Lymphedema (buildup of lymph fluid under your skin)
- Contracture (shortening and hardening of your muscles)
- Nerve damage
- Death