Avulsions and Degloving Injuries

Definition/Etiology:

An avulsion is an injury that involves peeling the skin from the underlying tissues. As the skin separates from the underlying tissue, it can lead to further tissue devascularization. When the skin is completely separated from the underlying tissue, it is considered a devloging injury. Imaging the skin on your hand was a glove, and you could actually pull all the skin from the muscle and bone, that’s what degloving looks like.

Most avulsions are described as proximal-based or distal based. Proximal-based avulsions usually have better circulation.

Typically, these wounds affect the hands or feet. They occur with machinery, or possibly MVC, or maybe even a bad fishing trip…can you say filet knife?

Pathophysiology:

The actual pathology of avulsions would be based on a traumatic injury. There are some medications that can make individuals more susceptible to an avulsion injury. For instance, corticosteroid use can lead to thinning skin and make it easier to suffer this type of injury.

Clinical Presentation:

The clinical presentation of an avulsion injury or a degloving would be….they are missing some of their skin! Not much more complicated than that. We need to assess the injury. Again, as in other trauma lectures, don’t forget to assess the whole patient. Just because they have no skin left on their hand, does not mean they are breathing!

Collaborative Management:

• Depending on the extent of the injury, we can determine the treatment. This can range from sutures to adhesive strips, to even just lying the skin back and place and placing a tegaderm over it.
• Before covering, you must make sure to thoroughly clean the area!
• Just because some of the edges of the skin may appear gray or dusky, does not mean they won’t heal. Do not trim these edges.
• If suturing, avoid lido or epi as these are vasoconstrictive and can further compromise blood flow to the avulsed fragment.

Evaluation | Patient Monitoring | Education:

Evaluation of these injuries in the ER will depend on the injury. If there is a complete degloving, it’s likely they will go to the OR, whether it’s for grafting, or simply debridement and wound care. If it’s a simple avulsion that will be discharged from the ED, make sure we stress the need to keep it clean and follow up for wound checks.

Linchpins: (Key Points)

• Clean the area
• No lido
• Cover appropriately