Types of Degloving Injuries
Various types of degloving injuries occur and these include Laceration type, Partial thickness, and Circumferential. These types of injuries can cause long-term effects and are important to know about.
Circumferential degloving injuries
Managing circumferential degloving injuries of the digits is a challenging task. Depending on the anatomy of the injury site, the options for treatment are varied. Some treatments involve the use of skin grafts while others involve reconstructive surgery.
The first priority is to save as much skin as possible. If possible, the injured skin is resurfaced by a plastic surgeon. The goal is to resurface the finger with a good quality, flexible skin. If the injury is more severe, reconstructive surgery may be required.
The study was conducted at the Muhawesh Training and Research Hospital (MTRH) in Eldoret Town- Uasin Gishu County, Western Kenya. A prospective, descriptive study was conducted with data collected using a Microsoft Access database. The study aimed to evaluate the early complications of degloving injuries.
Infection was a common complication. Other early complications included graft failure and local wound infection. These complications were significantly associated with the pattern of degloving injuries.
The most common mechanism for degloving injury is a motor vehicle accident. However, amputations may also be required. During the treatment of degloving injuries, health professionals must make important decisions quickly.
Treatment options include skin grafting, reconstructive surgery, and amputation. The most common early complications associated with these injuries include local wound infection, graft failure, and hemodynamic instability.
In most cases, the vascularity of the remnant tissues is preserved. However, in some cases, the vascularity is compromised, resulting in avascular necrosis. In these cases, the distal phalange may be amputated. In addition, reconstruction may be necessary, which may require complex meshes or biologic mesh.
The study included 48 patients with degloved skin. The photographs were taken from two different perspectives. The images were coded cleaned and then entered into a Microsoft Access database.
Laceration-type degloving injuries
Among the many medical injuries, degloving injuries can be quite gruesome and life-threatening. This type of injury can result in severe tissue death, blood loss, and injury to nerves and blood vessels. It can also result in disfigurement and loss of intimacy.
These injuries usually require complex medical procedures. Some patients may even require amputation. They may also require therapy or rehabilitation. A surgeon may use skin grafts or other skin substitutes to repair the injured area.
The initial step in treating a degloving injury is stabilizing the patient in the hospital. Once the wound has been cleaned, sterile bandages are applied to keep the blood flowing. The patient may also receive IV fluids and antibiotics as a prophylactic measure.
Surgeons may perform complicated microsurgery to reconnect severed nerves and blood vessels. They may also replant the skin to the original position, or they may use skin flaps to cover exposed flesh.
Degloving injuries can be found on any part of the body. However, the most common areas for degloving injuries are the extremities. If the injury is severe, it may require amputation. These injuries also tend to be associated with underlying fractures.
The symptoms of closed degloving injuries include bruising, swelling, and pain. They can also affect the torso, shoulder blades, and lower spine. The wounds may not be noticeable without a medical examination.
Open degloving injuries, on the other hand, are more obvious. They involve ripping off a large portion of skin, and may cause infection. These injuries may also be associated with muscle and bone fractures.
The most common treatment for degloving injuries is a skin flap. Doctors may also perform revascularization, which restores blood flow to the injured top layer of skin.
Ring avulsion injuries
Typical ring avulsion injuries involve a combination of bone and soft tissue. They are most often attributed to falls, sports injuries, and workplace accidents. These types of injuries can occur when the ring becomes caught on something, such as a metal piece of equipment.
Fortunately, ring avulsion injuries do not occur very often. However, they are a devastating injury that can result in extensive surgeries and medical expenses.
When an avulsion occurs, the blood supply to the finger is cut off. Avulsions usually leave the tendons and bone behind. However, in more severe cases, the skin is stripped off and the bones exposed. This results in the loss of a limb. Replantation of the amputated finger will not restore the original function of the digit.
Although amputation is often the preferred treatment for these injuries, some patients may benefit from microsurgical revascularization. These procedures can be performed on patients with severe ring avulsions without complete amputation.
A thorough evaluation of ring avulsion injuries will help identify neurovascular injuries. In addition, a thorough evaluation will allow physicians to determine whether tendon injuries are present.
Emergency physicians must be able to recognize a distinctive injury pattern to ensure timely care. A failure to recognize the injury can lead to long-term morbidity and delayed care.
There are several classification systems that have been developed to standardize reconstructive management of ring avulsion injuries. These systems are based on blood loss, damage to surrounding tissue, and the degree of neurovascular compromise.
The Kay classification system rates injuries from least severe to most severe. These categories were derived from clinical examinations and radiographs of the digits. The injury was categorized into two classes: avulsions of the proximal interphalangeal (PIP) joint and distal interphalangeal (DIP) joint.
Partial-thickness vs full-thickness degloving injuries
Depending on the severity of the injury, the treatment may vary. Patients may need to undergo reconstruction surgery or therapy. This can leave the victim with a permanent scar. In addition, the injury can cause psychological problems and post-traumatic stress disorder. Amputation may be required in cases where life is at risk.
Degloving soft tissues injuries (DSTIs) are serious surgical conditions. They involve lesions of the fasciocutaneous perforators and musculocutaneous segmental vessels. The mechanism of injury can be tissue abrasion or avulsion.
Degloving injuries are divided into two categories: open and closed. Open degloving injuries affect the head, neck, and scalp, while closed injuries affect the lower extremity. The tissue viability of open and closed degloving injuries is supposed to be a key determinant of outcome and morbidity. Unfortunately, data on tissue viability is lacking.
A study in South Africa evaluated 16 closed degloving injuries over a year period. Among the patients, the mortality rate was higher in closed injuries. In fatal cases, severe associated injuries were more common than in nonfatal cases. This led to increased length of hospital stay and mortality.
The study found that the incidence of reattached avulsed skins was between 10 and 50 percent. However, there was no evidence to suggest that reattached skins had a positive effect on the outcome. The grafts were held in place by skin staples.
Reattached skins tended to have large tissue defects and were not viable. In addition, the reattached skins were prone to necrosis.
For patients with wide zones of multiplanar degloving, primary amputation may be required. In patients with less severe injuries, skin grafts or skin flaps may be used.
Degloving injuries can be difficult to diagnose. They are most common in children and the elderly.
Depending on the type of degloving injury, the long-term effects can range from painful to severely damaging. Besides the physical damages, there are also emotional and mental problems that can be associated with this type of injury.
Open degloving injuries involve the tearing of the skin flaps from underlying tissues. These injuries can be very dangerous, as they can expose the muscles and bones in the affected area. Symptoms include pain, swelling, and bruising. If the skin is completely torn, it can cause gangrene, which is a condition where flesh dies because it lacks blood supply.
Open degloving injuries are usually accompanied by underlying fractures. Doctors may perform amputations or skin grafts to treat them. In severe cases, surgeons may even attempt to reconnect the severed blood vessels and nerves. This is known as complicated microsurgery.
Open degloving injuries may also lead to severe bleeding. Losing blood can lead to dehydration, resulting in a decrease in blood pressure. In addition, the skin can become infected, causing gangrene. In cases of infection, doctors may have to use biologic mesh to repair the affected area.
The most common body parts to suffer from degloving injuries are the face and legs. These injuries are very painful, and they can affect the earning capacity of victims.
Open degloving injuries tend to occur in young males. They may occur after an accident. They can affect the face, ears, nose, and eyelids.
Depending on the severity of the injury, victims may require therapy, physical therapy, or rehabilitation. Doctors may also recommend compression bandages. These treatments are often necessary to keep the wound from getting infected.
Degloving injuries are not easy to diagnose, and they can be extremely traumatic. Doctors may have to perform microsurgery to reconnect nerves, blood vessels, or severed skin flaps.