Degloving Injuries From Accidents

Degloving, also referred to as avulsion, is a significant and severe injury that occurs when the topmost layers of skin begin to peel off as when removing a glove. The skin rips off the bone, muscle, or tissue and slides off the body. In many cases, this type of injury can be life-threatening.

The legs are most likely to develop degloving injuries, but they can occur on various body parts, including the limbs, torso, face, scalp, and genital area.

This article discusses the effects of degloving, the recovery process for nonfatal injuries, and the long-term effects associated with degloving.

Skin Effects and Severe Risks of Degloving Injuries

Degloving can occur in various areas of the body. While degloving typically occurs on the legs, other body parts can be affected as well, such as:

• Hands
• Arms
• Feet
• Torso
• Face
• Scalp
• Genitals

Degloving also occurs in two different types: open and closed. Open degloving occurs when the skin and underlying tissues are ripped away, exposing the bones, muscles, or connective tissue.

Closed occurs without the obvious signs of degloving and can present as simple bruises. The skin doesn’t completely separate from the body, but rather, upper tissues and skin are detached from deeper connective tissues underneath the skin.

When a person experiences a high-level trauma and degloving occurs, the effects the injury has on the skin can lead to severe risks. Several factors are taken into consideration regarding degloving injuries and their severity, such as:

• Whether the injury is open or closed
• The part of the body affected
• Other injuries to the area affected (i.e., broken bones and fractures)
• The force of the injury that occurred

Degloving causes skin effects that require immediate medical attention, as these injuries are severe in nature. They include:

• Exposed bone, joints, tendons, and cartilage
• Damage to the veins in the area affected
• Part of the skin may remain attached
• Pain and swelling can occur
• Severe pain in the area
• Blood loss
• Permanent damage to nerves

Because of the nature of the trauma in degloving injuries, there are some severe risks associated with these types of injuries. They include:

• Severe blood loss that can lead to death
• Shock
• Infection
• Lack of blood supply to the area leading to tissue death
• Necrotizing fasciitis, an infection that destroys deep tissues

The risk of complications and infections increases in certain individuals, such as:

• People who smoke cigarettes
• Those with metabolic diseases or conditions, including diabetes and obesity
• Those with cardiovascular issues, such as those with coronary artery disease or hypertension

While degloving can be severe regardless of where it occurs, the area of the body with the highest risk of morbidity (disease) and potential death is the lower limbs. The scalp and external genitalia also come with a high risk of death.

A Word From Verywell

While degloving injuries are not very common, it is important to remember to use protective equipment, especially when working with heavy machinery to avoid these kinds of injuries.

— MICHAEL MENNA, DO, MEDICAL EXPERT BOARD

Degloving Recovery Process

The recovery process following a degloving injury can be challenging and complex. In the more severe cases, amputation of limbs may be required.

People who receive amputations will have to undergo a recovery process that includes:

• Medication
• Physical therapy
• Occupational therapy to help adapt to life afterward
• Rehabilitation for psychological grief following the loss of a limb

Those who do not have to undergo amputation still have a long road to recovery. People with degloving injuries are likely to be hospitalized for some time while the wound is being treated.

The length of stay in the hospital will vary, depending on the severity of the injury, but studies show that the typical length of time is between 21 and over 30 days.

Following hospitalization, people who have had degloving injuries are required to participate in outpatient care and follow-up care to ensure that there is no infection and to assess the damage in terms of loss of sensation in the affected area.

Degloving-Associated Accidents

Degloving is one of the most severe injuries that can occur. Typically, it is driven by workplace accidents, car accidents, and other similar high-level injuries, such as:

• Motorcycle accidents
• Falls from high heights
• Animal bites
• Sports-related accidents

These accidents are increasingly traumatic, sometimes resulting in the degloving of the skin.

Treating Degloving Injuries

Treating degloving depends on the type and how severe it is. If a person has also broken the bone because of the nature of their accident, that will require treatment as well.

Open degloving is treated using one or more of the following methods:

• Skin grafts to replace lost skin
• Skin flaps
• Replacing the skin that has peeled off back onto the area
• Amputation
• Intravenous antibiotics to combat any possible infections
• Covering the affected tissue

For closed degloving injuries, compression bandages work best for mild injuries to help keep the skin in place as it heals. If the injury is more severe, though, fluid drainage will need to be done along with the removal of any dead tissue.

Long-Term Effects and Degloving Follow-Up

The effects of degloving can continue long after the injury has begun to heal. Because of the nature of the injury, it can be difficult to integrate back into daily life while recovering. People may want to opt for surgical options to help reduce scarring or reconstruct the area, but these procedures can increase the risk of infection and scarring.

People who had to have a limb amputated because of a degloving injury will also have to work toward adjusting to their new physical body. This will often include long-term physical and occupational therapy, alongside psychological treatment, to combat any mental anguish that can go hand-in-hand with amputations.

Summary

Degloving injuries are severe in nature and can be life-threatening, especially if they are not treated soon after they occur. Blood loss and infection of the affected area can increase the risk of death following a degloving injury. Typically, these injuries occur after workplace or car/motorcycle accidents.

They are high-level emergencies requiring long recovery time and complex treatment plans. While recovery is challenging after a degloving incident, it's not impossible. Many people with these types of injuries live long and healthy lives following a degloving injury.