Degloving injury

Background

• Severe avulsion injury resulting in skin and subcutaneous fat separating from the underlying tissues
• Can present on any part of the body, but most commonly affects lower extremities
• Important to recognize quickly, as they are often associated with high morbidity/mortality
  • Delayed diagnosis can lead to full-thickness necrosis, or even necrotizing fasciitis

Clinical Features

• Soft tissue loss of varying degrees
  • Limited loss with abrasion/avulsion
  • Non-circumferential
  • Circumferential in single plane
  • Circumferential multiplane
• Often related to other severe injuries, including neurovascular damage
  • Avulsed tissue is often nonviable

Differential Diagnosis

Extremity trauma

• Compartment syndrome
• Contusion
• Crush syndrome
• Degloving injury
  • Morel-Lavallée lesion
  • Ring avulsion injury
• Fracture
  • Open fracture
• Laceration
• Myositis ossificans
• Open joint injury
• Peripheral nerve injury
• Rhabdomyolysis
• Tendon injury
• Vascular injury

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Evaluation

• Clinical diagnosis, but important to assess for concomitant injuries
• Assess distal neurovascular function

Management

• Surgical consult- will need debridement/repair and eventual skin grafting in OR
• Antibiotics
  • Cefazolin
• Resuscitation with IVF/blood products

Disposition

• Admit

See Also

• Morel-Lavallée Lesion