Degloving

What Is It, Causes, Clinical Presentation, and More

Author: Maria Emfietzoglou, MD

Editor: Alyssa Haag

Editor: Emily Miao, PharmD

Editor: Kelsey LaFayette, DNP, RN, FNP-C

Illustrator: Jessica Reynolds, MS

Copyeditor: Stacy M. Johnson, LMSW

Modified: Dec 12, 2022

What is degloving?

Degloving occurs when a part of the skin, with or without the underlying soft tissue, becomes wholly or partially detached from the body, like a glove stripped off a hand. A degloving injury can be life-threatening and needs to be treated as soon as possible.

Middle finger with part of the skin and underlying soft tissue partially detached.

What causes degloving?

Degloving can develop when a part of the body gets caught on something and forcefully pulls away. As a result, the skin and underlying soft tissue may detach from the body. For instance, a degloving injury can occur from forcefully removing a ring from a finger, when a tire runs over an individual’s foot, a sports accident, or an accident involving industrial or farm equipment.

What are the signs and symptoms of a degloving injury?

A degloving injury can occur anywhere on the body. However, it most commonly affects the upper or lower extremities. Degloving can lead to open degloving injuries, where the skin, with or without the subcutaneous tissue, is ripped off, exposing the underlying fascia, muscles, and bones.

The skin may be completely detached from the body or remain partially attached and hanging near the wound. In some cases, degloving can result in a closed degloving injury, also known as Morel-Lavallee lesion, where the skin layer remains intact despite being separated from the underlying tissue. Individuals with degloving often also experience pain and swelling of the affected area.

How is degloving diagnosed?

Diagnosis of degloving is typically based on clinical presentation and mechanism of injury. It is essential to determine the extent of the injury and identify whether there is an accompanying fracture or vascular compromise, as these are surgical emergencies. Additionally, skin viability is assessed based on clinical findings, such as skin discoloration, decreased cutaneous sensation, and atypical skin temperature. The clinician may also look for tenderness and swelling of the affected area. Additional diagnostic tests may be required, including needle aspiration of the area, ultrasound, CT, and MRI, to confirm the extent and severity of the injury.

How is a degloving injury treated?

Degloving injuries are treated promptly to save the skin and underlying subcutaneous tissue, if applicable, and debride ischemic or necrotic skin. Once a degloving injury is identified, management usually starts with administering IV fluids and antibiotics, such as first-generation cephalosporins (e.g., cefazolin), to minimize the risk of infections. For open degloving injuries, the treatment also focuses on covering the tissue that has been degloved. Placing the degloved skin or skin from other body parts can be done through plastic surgery over the wound. A skin graft (i.e., skin transferred without a blood supply) or a skin flap (i.e., skin transferred with its blood supply) can be utilized. Of note, skin flaps usually provide better cosmetic results and have lower chances of failure (i.e., unsuccessful incorporation into the recipient site) than skin grafts.

Severe cases of degloving, where the injury is deep, or there is severe blood loss, can be life-threatening and may require amputation. Closed degloving injuries can be managed with compression bandages if mild or fluid drainage and removal of dead tissue if more severe.

What are the most important facts to know about degloving?

Degloving occurs when part of the skin and subcutaneous tissue becomes wholly or partially detached from the body. Degloving typically develops when part of the body, usually an upper or lower extremity, gets caught on something and is pulled away forcefully. There are two types of degloving injuries. Open degloving occurs when skin or subcutaneous tissue is ripped off. Closed degloving is where the top skin layer remains intact despite being separated from the underlying tissue. Degloving injuries are diagnosed clinically and require immediate medical attention with the administration of IV fluids and antibiotics. Treatment options include necrotic tissue debridement, reattachment of the degloving skin; placement of skin grafts or skin flap; or even amputation.

References

Tampa General Hospital. Degloving Injuries. Retrieved 7th May 2022 from https://www.tgh.org/institutes-and-services/conditions/degloving-injuries

Healthline. Degloving injuries. Retrieved 7th May 2022 from https://www.healthline.com/health/degloving

Oxford Medicine Online. Degloving Injuries. Retrieved 7th May 2022 from https://oxfordmedicine.com/view/10.1093/med/9780198849360.001.0001/med-9780198849360-chapter-4

Krishnamoorthy R., Karthikeyan G. Degloving injuries of the hand. Indian J Plast Surg. 2011;44(2):227-236. doi:10.4103/0970-0358.85344

Latifi, R., El-Hennawy, H., El-Menyar, A. et al. The therapeutic challenges of degloving soft-tissue injuries. J Emerg Trauma Shock. 2014;7(3):228-232. doi:10.4103/0974-2700.136870

McGowan, S.P., Fallahi, A.K.M. Degloving Injuries. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557707/

Hak, D.J., Olson, S.A., Matta, J.M. Diagnosis and management of closed internal degloving injuries associated with pelvic and acetabular fractures: the Morel-Lavallée lesion. J Trauma. 1997 Jun;42(6):1046-51. doi: 10.1097/00005373-199706000-00010. PMID: 9210539.

TeachMe surgery. Skin grafts and skin flaps. Retrieved 08th of May 2022 from https://teachmesurgery.com/plastic-surgery/burns/skin-grafts-and-flaps/