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Muscle degloving, also known as a degloving injury, is a serious, sometimes fatal, and often traumatic injury that occurs when the top layers of skin and tissue are torn away from the underlying muscle, connective tissue, or bone. This injury can occur anywhere on the body but is most common in the legs, face, scalp, torso, arms, hands, feet, and limbs. It is frequently associated with underlying fractures and can lead to severe blood loss, tissue death, necrosis, and even amputation. Determining the extent of a degloving injury can be difficult, as the external appearance of the skin may not reveal the full extent of the internal damage. Treatment for a degloving injury will depend on the severity, location, and available resources but may include skin reattachment, skin grafts, limb reattachment, or amputation.
| Characteristics | Values |
|---|---|
| Definition | A serious injury where the skin and tissue rip away |
| Type | Open degloving, closed degloving |
| Severity | Can be life-threatening |
| Location | Anywhere on the body, most common areas include the arms, legs, face, scalp, torso, hands, feet, trunk, limbs, genitalia |
| Symptoms | Pain, swelling, disfigurement, bruising, necrosis, infection, skin hypermobility, decreased sensation |
| Treatment | Skin reattachment, skin grafts, skin flaps, reconstructive surgery, amputation, compression bandages, fluid drainage, removal of dead tissue, antibiotics, IV fluids |
| Diagnosis | MRI scan, needle aspiration, ultrasound, CT scan |
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What You'll Learn
Morel-Lavallee lesions
A Morel-Lavallée lesion (MLL) is a closed soft-tissue degloving injury that usually occurs after blunt trauma. It was first described in 1853 by French physician Maurice Morel-Lavallée. These injuries are uncommon and are frequently undetected, often presenting days to weeks after the initial injury.
Morel-Lavallée lesions are post-traumatic, internal degloving injuries that occur deep in the subcutaneous plane due to the disruption of capillaries. This results in an effusion containing hemolymph and necrotic fat. The injury causes the skin and subcutaneous tissues to separate from the fascia, creating a potential space that fills with serosanguinous fluid, blood, and necrotic fat. The lesion typically presents as a painful fluctuant swelling at the site of injury.
Magnetic resonance imaging (MRI) is the modality of choice for evaluating Morel-Lavallée lesions due to its high contrast resolution, multiplanar acquisition, and detailed anatomical imaging. Early diagnosis and management are crucial as delays can lead to infection, lesion expansion, overlying skin necrosis, and underlying fracture exposure.
Treatment options for Morel-Lavallée lesions include conservative management with compression bandages and surgical drainage. However, once the lesions become established and encapsulated, conservative management is often unsuccessful, and surgical intervention may be necessary to prevent reaccumulation. Open debridement is considered in cases with open fractures, chronic lesions with infection or tissue necrosis, and longstanding lesions with pseudocapsules unresponsive to percutaneous drainage.
Morel-Lavallée lesions commonly occur at the greater trochanter but have also been observed at the flank, buttock, lumbar spine, scapula, and the knee. They are often associated with sports injuries caused by shearing forces, resulting in the separation of the hypodermis from the deeper fascia.
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Open and closed degloving injuries
A degloving injury occurs when a force pulls or tears away the skin and subcutaneous tissue from the underlying muscle. It is a traumatic injury that can result from various high-impact incidents, including motor vehicle accidents, blunt force trauma, and entanglement in machinery. Degloving injuries can vary in severity, ranging from partial-thickness degloving, where only the top layers of skin and subcutaneous tissue are affected, to full-thickness degloving, where the damage extends deeper and involves the exposure of muscles, tendons, and bones. These injuries are serious and often result in long-term functional and aesthetic complications for patients.
There are two types of degloving injuries: open and closed. Open degloving injuries are characterized by complete skin disruption, with the underlying tissues exposed to the external environment. This type of injury is typically caused by shearing or avulsion forces that separate the skin and subcutaneous tissue from the muscle. Open degloving injuries present as obvious wounds, with visible detachment of the skin and associated bleeding. The severity can range from small, localized areas of skin loss to extensive degloving involving large areas of the body. Open degloving injuries carry a high risk of infection due to contamination and require immediate medical attention.
Closed degloving injuries, also known as internal degloving or subsurface degloving, are less apparent and occur beneath intact skin. In this type of injury, the skin remains intact, but the underlying subcutaneous tissue and muscles are stripped away from their attachments. Closed degloving injuries are caused by compression forces that squeeze and push the skin and subcutaneous tissues away from the underlying muscles. This type of injury is often seen in crush injuries, compartment syndrome, and constriction injuries, where tight bands or clothing restrict blood flow and cause tissue necrosis. Closed degloving injuries can be challenging to identify, as the skin may appear normal, masking the extent of the damage underneath.
The management of open and closed degloving injuries differs significantly. Open degloving injuries require immediate wound care, including thorough irrigation and debridement of devitalized tissue to prevent infection. Depending on the size and location of the wound, various surgical techniques, such as skin grafts or local or free flaps, may be utilized for wound closure. In contrast, closed degloving injuries often require prompt decompression through escharotomies or fasciotomies to relieve compartment pressures and improve blood flow to ischemic tissues. Surgical exploration and debridement of non-viable tissues are usually necessary, followed by wound closure or coverage with skin grafts or flaps in a similar manner to open degloving injuries.
The prognosis and potential complications of open and closed degloving injuries depend on various factors, including the location, severity, and associated injuries. Both types of injuries can result in significant scarring, contractures, and long-term functional impairments. Open degloving injuries carry a higher risk of infection and may result in poor wound healing and chronic pain. Closed degloving injuries can lead to compartment syndrome, nerve damage, and muscle necrosis if not treated promptly and appropriately. In both cases, psychological impacts, such as body image issues and post-traumatic stress disorder, are common and should be addressed as part of the patient's overall management and long-term follow-up care.
Overall, open and closed degloving injuries are severe and complex traumatic injuries that require specialized care and management. Early recognition, appropriate wound care, and surgical intervention are crucial for optimizing patient outcomes and minimizing long-term complications. A multidisciplinary approach involving plastic surgeons, orthopedic surgeons, and rehabilitation specialists is often necessary to address the functional and aesthetic challenges associated with muscle degloving injuries.
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Diagnosis and treatment
Muscle degloving is a serious injury that requires immediate medical attention. The injury occurs when the skin and subcutaneous tissue become wholly or partially detached from the body. There are two types of muscle degloving injuries: open and closed.
Open degloving occurs when the skin or subcutaneous tissue is ripped off, exposing the underlying fascia, muscles, and bones. This type of injury usually requires emergency care to reduce blood loss and prevent infection.
Closed degloving, also known as Morel-Lavallée lesions, occurs when the skin layer remains intact despite being separated from the underlying tissue. These injuries are harder to identify and can lead to severe tissue death without treatment.
Determining the extent of a degloving injury can be difficult, as a visual assessment may not reveal the full extent of the damage. Open degloving injuries are generally easier to diagnose, as the muscle and bone will be exposed where the skin has been ripped away. Closed degloving injuries, on the other hand, may not show any major external signs of injury other than bruising. MRI scans are often used to diagnose closed degloving injuries, as they can detect Morel-Lavallée lesions.
The treatment for a degloving injury will depend on the type, severity, and location of the injury, as well as the availability of advanced trauma treatment at the hospital. In general, the first priority is to save as much of the patient's skin as possible. Less severe injuries can often be treated with skin grafts or skin flaps, while more serious injuries may require reconstructive surgery or even amputation.
For closed degloving injuries, less serious cases may be treated with compression bandages and physical therapy. More severe cases may require draining fluid from the lesion, removing dead tissue, and injecting blood vessels to help them shrink.
Replantation and revascularization are treatment options when the torn soft tissue can be reattached with proper blood flow. In cases where reattachment is not possible, skin flaps or skin grafting may be performed.
Treatment for open degloving injuries often involves covering the exposed tissue. This may include skin reattachment, skin grafts, or, in some cases, amputation.
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High-energy trauma
Degloving injuries are serious and sometimes fatal soft-tissue avulsion injuries that can occur anywhere in the body. They are caused by shearing forces that separate the layers of skin and tissue from the underlying muscle, bone, and connective tissue. These injuries are often the result of high-energy trauma, such as motor vehicle collisions, motorcycle accidents, or accidents involving industrial or farm equipment.
- Motor vehicle collisions: Car accidents are the most commonly reported mechanism of high-energy trauma associated with degloving injuries. The impact of a vehicle collision can cause the skin and tissue to rip away from the underlying structures, resulting in severe and life-threatening injuries.
- Motorcycle accidents: Motorcycle riders are particularly vulnerable to degloving injuries due to the lack of protection. A fall from a motorcycle or a collision can result in the violent separation of the skin and tissue from the underlying muscle and bone.
- Industrial or farm equipment: Accidents involving machinery, such as getting caught in conveyor belts or farm equipment, can lead to high-energy trauma and degloving injuries. The force of the equipment can rip the skin and tissue away from the body.
- Direct crush injuries: High-energy trauma can also occur from crush injuries, where a heavy object or force crushes the body, causing the skin and tissue to separate from the underlying structures.
The severity of a degloving injury depends on the force and location of the trauma. These injuries can range from minor to severe and can be life-threatening. Open degloving injuries occur when the skin and tissue are completely ripped away, exposing the underlying structures. Closed degloving injuries, on the other hand, are more complicated as the top layer of skin remains intact, but the underlying tissue has been separated. These closed injuries can be harder to identify and diagnose, often requiring advanced imaging techniques such as MRI scans.
The treatment for high-energy trauma-related degloving injuries depends on the severity and location of the injury. In some cases, immediate medical attention, including the administration of IV fluids and antibiotics, is crucial to prevent infections and manage the injury. Minor closed degloving injuries may be treated with compression bandages and physical therapy, while more severe cases may require fluid drainage, removal of dead tissue, and, in extreme cases, amputation. Reconstructive surgery, skin grafts, and flap procedures may also be necessary to heal the wound and restore function to the affected area.
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Complications and associated injuries
Degloving injuries are serious and sometimes fatal. They are often associated with accidents involving industrial or farm equipment, motor vehicle collisions, motorcycle accidents, or direct crush injuries. These injuries can occur anywhere in the body but are more common in the legs, face, scalp, hands, feet, torso, and arms.
Internal degloving injuries, also known as Morel-Lavallee lesions, can have significant associated morbidity, especially if overlooked. They are frequently associated with and complicate the treatment of fractures of the pelvis, acetabulum, or proximal femur. These lesions create a potential space for fluid collection, which can become a nidus for infection and put the overlying skin at risk for necrosis. Large lesions may require operative intervention, such as surgical incision and drainage, especially if skin necrosis occurs.
Recurrence is the most common complication of degloving injuries, with rates differing depending on treatment modalities. Percutaneous aspiration alone carries the highest risk of recurrence, while proper operative management has lower rates of recurrence. Larger lesions are more likely to recur, and the location of the injury does not seem to impact the recurrence rate.
Open degloving injuries are more likely to require advanced soft tissue coverage and multiple surgeries. They often result in significant blood loss and tissue death, which can lead to life-threatening situations. Treatment options for open degloving injuries may include skin reattachment, skin grafts, limb reattachment, or amputation.
Closed degloving injuries, on the other hand, are harder to identify as the top layer of skin remains intact. They may present with bruising, pain, and swelling in the affected area. Treatment for closed degloving injuries depends on their severity, with minor cases managed with compression bandages and physical therapy, while more serious cases may require fluid drainage and removal of dead tissue.
Overall, early treatment is crucial for degloving injuries to prevent infections and potential long-term effects.
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Frequently asked questions
Degloving is a serious, and sometimes fatal, injury where the skin and tissue rip away from the underlying muscle, connective tissue, or bone.
Symptoms include bruising, pain, swelling, and disfigurement of the affected area. Pain will depend on the severity of the injury.
Degloving injuries are caused by high-energy trauma, such as accidents involving industrial or farm equipment, motor vehicles, or motorcycles.
Treatment depends on the type, severity, and location of the injury. It can include skin reattachment, skin grafts, amputation, compression bandages, fluid drainage, removal of dead tissue, and injections into blood vessels.
Diagnosis is typically based on history and physical assessment. Morel-Lavallee lesions, a type of closed degloving injury, can be detected using an MRI scan.
