A degloving injury is the peeling away of layers of soft tissue. The skin and layers of internal tissue rip away from the body, like a glove being ripped off a person’s hand. Degloving is a potentially serious injury that requires emergency treatment.
Our experienced Wilmington workers’ compensation lawyers at Horton & Mendez Injury Attorneys explain what kind of treatment is required for a degloving injury.
Understanding the Severity of Degloving Injuries
A degloving injury is an avulsion injury, or the pulling or tearing away from the body. The dermis and deep fascia tear away in a shearing fashion. It can be a serious and even life-threatening injury.
In a healthy body, the skin is the outermost layer. Underneath that, there is fat, superficial fascia, more fat, deep fascia, and bone. When these layers are traumatized and they are pulled away, a degloving injury has occurred.
How do degloving injuries occur?
Degloving injuries are the result of severe trauma. Car accidents, animal bites, sports injuries, falls, and crushing accidents are common causes of degloving injury.
Injury may occur when a body part is caught and pulled at a relatively low speed. For example, in car accidents, being run over can cause a degloving injury. At work, a limb being stuck in a machine can be a cause. The greater the speed and forces involved, the more likely the person is to suffer accompanying skeletal injury.
Where do degloving injuries occur on the body?
Degloving injuries most commonly affect the following regions of the body:
- Hip
- Thigh
- Pelvis
- Knee
- Buttocks
- Lumbosacral region
- Abdominal area
- Lower leg
- Head
- Hand
Nearly all degloving injuries (93%) affect the pelvis or lower regions of the body.
A degloving injury can be open or closed. An open injury is a complete separation of the skin and internal tissue where the body’s internal tissues are exposed. A closed injury is a detachment that occurs underneath the skin. A closed injury is not readily apparent and may look like bruising.
Complications of degloving injury
A number of complications can occur, including bleeding, collection of fluid, and pooling of fat in the space that has been ripped open. Significant inflammation may occur, and there is a high risk of infection. Because of the lack of blood flow and direct trauma to the skin, the skin on top of the avulsion may suffer necrosis and tissue death.
Is a degloving injury a medical emergency?
Yes. Significant bleeding and shock can occur. The potential for secondary harm from infection must be mitigated, or tissue death may occur. These injuries may result in significant pain, numbness, and loss of feeling. Even more, a degloving injury and its complications may be fatal.
Initial Medical Response and Stabilization
Medical evaluation following trauma should consider the possibility of a degloving injury. Scans and ultrasound may assist in a diagnosis. The management of injury depends on the location and severity of injury, the health of the patient, and co-occurring harm. If other surgeries are necessary, treatment for degloving injury can be a part of the overall surgical plan.
Degloving treatment may include:
- Compressive therapy
- Needle aspiration
- Sclerodesis, drainage
- Surgical irrigation
- Debridement
- Skin grafting
- Physical therapy
- Antibiotics, medication
Ideally, the skin would be reimplanted. If it can receive blood flow, it may again become healthy, connected tissue. However, the injury may be too severe for reimplantation to succeed.
If the overlying skin is viable, care may be minimally invasive and even managed with compressing wraps and other external measures. The larger the injury, the more likely the patient will need surgery. There is a risk of recurrence, which increases with the severity of injury.
Degloving injury management begins with stabilization. If there are accompanying bone fractures, they must be addressed. Immediate care should focus on identifying the injury and minimizing complications. Then, rehabilitation efforts can begin.
Skin Grafts and Reconstruction
Skin grafts may be appropriate for management of a degloving injury. Plastic surgery may cover wounds and place tissue. Infection management should be a consideration during care, and multiple procedures may be necessary. The length of recovery may be measured in months or years.
Although a skin graft may be significantly beneficial, it may not result in complete recovery. Take hand injuries, for example. The groin is a common site for donor flaps of skin, along with the abdomen, radial forearm, and thigh. However, these donor flaps of skin cannot completely restore sensation in the hand, and the person is likely to suffer from reduced ability to grip and pinch. Donor flaps from the toe may be effective to return some measure of sensory perception to an affected hand. Skin grafts may also help to reduce scars.
Role of Therapy in Recovery
The patient must be an appropriate candidate for physical therapy, given their other injuries.
Physical therapy may help the patient regain strength and flexibility. For a hand injury, it may improve the ability to grip and pinch.
Physical therapy can also help a person learn coping skills. They can adapt to their new limitations, especially if amputation is necessary or disfigurement results. In addition to physical therapy, psychological care may be important.
Long-Term Care and Rehabilitation for Degloving Injuries
The need for hospitalization depends on several factors:
- Severity of the injury
- Response to surgery and other interventions
- Health of the patient, including risk factors
- Co-occurring injuries
- Infection and other secondary harm
It is common for treatment to require more than 30 days of residential care. Additional outpatient visits will likely be required to ensure that there is no infection or other complication.
Appropriate management can result in a significant reduction in recurrence.
Contact an Experienced Wilmington Workers’ Compensation Lawyer
Degloving injuries may occur on the job. If you have been hurt, we invite you to contact an experienced Wilmington workers’ compensation lawyer. At Horton & Mendez Injury Attorneys, we understand how companies try to avoid paying workers fairly.
Our lawyers are dedicated trial lawyers who vigorously fight for our clients. Contact us now to talk about your situation and get legal help today.
