Degloved face injuries are associated with traumatic events such as car accidents.
A degloving injury or an avulsion is a traumatic injury. It results in the top layers of skin and the tissue underneath being torn away from the underlying muscle, connective tissue, or bone, severing its blood supply.
Degloving injuries often affect the extremities and limbs and are frequently associated with underlying fractures.
A degloved face occurs when a large piece of skin and the layer of soft tissue under it gets partially or completely ripped due to major trauma, such as car accidents or incidents involving heavy machinery (such as conveyor belts) and interpersonal violence. A controlled facial degloving is often featured in plastic surgeries of the face.
Because they typically involve severe blood loss and tissue death, they are often life-threatening.
It is named after an analogy to the process of removing a glove because the skin will be stripped back from the injured area like a glove.
What causes degloving injuries?
Degloving injuries are often associated with accidents involving industrial or farm equipment, but there are several other potential causes, including:
- Motorcycle accidents
- Car accidents
- Sports mishaps
- Animal bites
- Falls from heights
- Construction accidents
2 types of degloving injuries
- Open degloving injury
- The skin and tissue are ripped away and the muscles and bones underneath are exposed, whereas in some cases, the skin may still be partially attached and hanging as a flap near the wound.
- The most common areas are the legs, torso, scalp, and face.
- Are usually caused by:
- Traffic accidents
- Accidents with industrial or farm equipment
- Falls from heights
- Sports injuries
- Animal bites
- Closed degloving injury
- The top layer of skin remains intact although it has been separated from the tissue underneath it.
- May involve a force that separates the top layer of skin and tissue from deeper tissues, leaving a space under the skin, called Morel-Lavallee lesions, which can be filled with lymph fluid, blood, and fat.
- Mostly seen at the top of the hip bone in an area called the greater trochanter, torso, buttocks, lower spine, shoulder blades, and knees.
How to diagnose degloving injuries
Degloving injuries are diagnosed by a doctor based on careful medical examination and history of injury. They may order investigations to determine the extent of the damage. Determining the extent of a degloving injury is difficult because visually assessing the degloved skin might not reveal the full extent of the injury.
- Moreover, skin viability tends to be a difficult analysis when using subjective criteria, such as bleeding, skin color, temperature, and pressure reaction.
- Open degloving injuries are comparatively easier to diagnose because muscle and bone might get exposed where the skin has been ripped away than closed degloving injuries.
- It may not be obvious that the top layer of skin has detached from deeper layers of tissues.
How are degloving injuries treated?
The treatment options for a degloving injury may vary depending on the severity, location, and presence of broken bones.
Treatment for open degloving injuries may include:
- Replantation or revascularization of the degloved skins
- Reconstructive surgeries
- Reattachment of fingers or toes
- Skin grafts or skin flaps
- Post-operative physiotherapy
Treatment for less serious closed degloving injuries may include:
- A combination of compression bandages and physical therapy
For more severe cases, treatment options may include:
- Draining any accumulated fluid from the lesion
- Removal of dead tissues
- Sclerotherapy involves injecting blood vessels with medication to shrink them
A facial degloving injury is a complex reconstructive challenge that requires a staged approach for optimal cosmetic and functional outcomes. Appropriate airway maintenance, radicle debridement, and layered and proper alignment of tissues to their respective positions are instrumental to achieving good results.