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. 2016 Jul 27:11:35.
doi: 10.1186/s13017-016-0093-2. eCollection 2016.

Patterns and management of degloving injuries: a single national level 1 trauma center experience

Suhail Hakim  1 , Khalid Ahmed  1 , Ayman El-Menyar  2 , Gaby Jabbour  1 , Ruben Peralta  1 , Syed Nabir  3 , Ahammed Mekkodathil  4 , Husham Abdelrahman  1 , Ammar Al-Hassani  1 , Hassan Al-Thani  1
Affiliations

Patterns and management of degloving injuries: a single national level 1 trauma center experience

Suhail Hakim et al. World J Emerg Surg. .

Abstract

Background: Degloving soft tissue injuries (DSTIs) are serious surgical conditions. We aimed to evaluate the pattern, management and outcome of DSTIs in a single institute.

Methods: A retrospective analysis was performed for patients admitted with DSTIs from 2011to 2013. Presentation, management and outcomes were analyzed according to the type of DSTI.

Results: Of 178 DSTI patients, 91 % were males with a mean age of 30.5 ± 12.8. Three-quarter of cases was due to traffic-related injuries. Eighty percent of open DSTI cases were identified. Primary debridement and closure (62.9 %) was the frequent intervention used. Intermediate closed drainage under ultrasound guidance was performed in 7 patients; however, recurrence occurred in 4 patients who underwent closed serial drainage for recollection and ended with a proper debridement with or without vacuum assisted closure (VAC). Closed DSTIs were mainly seen in the lower extremity and back region and initially treated with conservative management as compared to open DSTIs. Infection and skin necrosis were reported in 9 cases only. Open DSTIs were more likely involving head and neck region and being treated by primary debridement/suturing and serial debridement/washout with or without VAC. All-cause DSTI mortality was 9 % that was higher in the closed DSTIs (19.4 vs 6.3 %; p = 0.01).

Conclusion: The incidence of DSTIs is 4 % among trauma admissions over 3 years, with a greater predilection to males and young population. DSTIs are mostly underestimated particularly in the closed type that are usually missed at the initial presentation and associated with poor outcomes. Treatment guidelines are not well established and therefore further studies are warranted.

Keywords: Debridement; Degloving; Management; Soft tissue injury; Trauma.

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Figures

Fig. 1
Fig. 1
Distribution of anatomic site of degloving soft tissue injuries (DSTI)
Fig. 2
Fig. 2
Open degloving with flap and underlying bony injury
Fig. 3
Fig. 3
Closed degloving with frank bruising but intact skin
Fig. 4
Fig. 4
Morel Lavallee lesion (common site) and Coronal CT view of the lesion
See this image and copyright information in PMC

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