A degloving skin injury is a severe form of trauma where a large section of skin and the soft tissue immediately beneath it are forcefully separated from the underlying structures, such as muscle, connective tissue, or bone. The term “degloving” visually describes the result, which resembles a glove being peeled off a hand, though the injury can occur anywhere on the body, frequently in the limbs or torso. This type of injury is a medical emergency because it often disrupts the blood supply to the detached tissue and exposes underlying nerves and vital structures.
The Physical Forces Causing Tissue Separation
A degloving injury results from the application of massive external force that exceeds the natural structural integrity of the body’s soft tissues. The trauma involves a specific combination of friction and tangential shearing stress. This shearing force occurs parallel to the body’s surface, pulling the skin and subcutaneous fat in one direction while the deeper, anchored structures remain fixed.
The skin is normally anchored to the deep fascia, a dense layer of connective tissue covering the muscles, by a network of thin, fibrous septa within the subcutaneous fat. When a high-energy tangential force is applied, this delicate network tears, separating the superficial fascia from the deep fascia. This separation severs the tiny perforating blood vessels and lymphatic channels that supply the skin. The result is a traumatic detachment that creates a potential space beneath the skin, often accompanied by significant damage to the detached tissue.
Specific Circumstances That Cause Degloving
The intense forces required to cause this tissue separation are generated in specific, high-energy trauma scenarios. High-speed motor vehicle accidents, particularly motorcycle crashes where a rider slides along the pavement, are a common cause of open degloving injuries. In these “road rash” incidents, the combination of high velocity and friction against a rough surface strips the tissue away.
Industrial and agricultural settings also present a significant risk, especially where limbs can be caught in machinery like conveyor belts, rollers, or presses. The crushing and pulling action of these mechanisms exerts the necessary shear force. Other causes include a ring avulsion injury, where a ring catches on an object and the force of the pull degloves the finger, falls from substantial heights, and direct crush injuries involving a heavy object glancing across the body.
Open vs. Closed Degloving Injuries
Degloving injuries are classified into two distinct types based on the integrity of the overlying skin. An open degloving injury, also known as a true avulsion, is the most visually dramatic presentation. Here, the skin and soft tissue are completely torn away or left as an open flap, exposing the underlying muscle, bone, or tendons.
The other category is the closed degloving injury, commonly known as a Morel-Lavallée lesion. This occurs when the internal shear force separates the skin and subcutaneous layer from the deep fascia without breaking the skin. This traumatic separation creates a large, internal cavity that rapidly fills with blood, lymph fluid, and necrotic fat. Because the surface skin remains unbroken, this lesion can initially be mistaken for a severe bruise or swelling, often leading to a delayed diagnosis.
Immediate Medical Stabilization and Triage
Immediate medical management focuses on stabilizing the patient and preserving viable tissue. For open degloving injuries, the primary concern is controlling massive hemorrhage, as the disruption of large blood vessels can lead to significant blood loss and hypovolemic shock. Emergency medical personnel apply direct pressure to the wound or may use a tourniquet to stem the flow of blood.
Shock prevention is another immediate priority, which includes managing pain and keeping the patient warm and calm while awaiting transport to a trauma center. The exposed wound must be protected with sterile dressings to minimize contamination and the risk of infection. If any detached tissue is recovered, it must be preserved properly, usually wrapped in a clean, cool medium, as it may be used later for re-implantation or grafting procedures. Initial hospital care often involves a thorough assessment for associated injuries, such as fractures, which frequently accompany the high-energy mechanism of degloving trauma.