The online version of this article (https://doi.org/10.1186/s13018-017-0706-9) contains supplementary material, which is available to authorized users.
Degloving injuries are surgical conditions in which an extensive portion of skin and subcutaneous tissue is detached from the underlying fasciae, muscles, or bone surface. Frequently, there is an association of fracture underlying the degloved area. We aimed to compare the short-term outcomes of degloving injuries with and without underlying fracture.
A prospective cohort study was conducted. We recruited patients with degloving injuries, and followed them up for 30 days to assess the outcomes. We collected data on socio-demography, cause and mechanism of injury, presence of underlying fracture, presence of shock at admission, injury severity score, location and size of degloving injuries, their management, and short-term outcomes. There were two comparison groups of degloving injuries based on the presence or absence of underlying fracture. We analyzed the differences between the two groups by using Fisher exact test for categorical variables and Student’s t test for continuous variables; p values < 0.05 were considered to be significant. Risk ratio was calculated for the short-term outcomes.
There were 1.56% (n = 51) of degloving injuries among 3279 admitted trauma patients during the study period of 5 months; 1% (n = 33) with and 0.56% (n = 18) without underlying fracture. For the overall degloving injuries, male-female ratio was 2 and mean age was 28.8 years; they were caused by road traffic crashes in 84%, and resulted in shock at admission in 29%. In the group with underlying fracture, lower limbs were frequently affected in 45% (p = 0.0018); serial debridement and excision of the avulsed flap were the most performed surgical procedures in 22% (p = 0.0373) and 14% (p = 0.0425), respectively; this same group had 3.9 times increased risk of developing poor outcomes (mainly infections) after 30 days and longer hospital stay (26.52 ± 31.31 days, p = 0.0472).
Degloving injuries with underlying fracture are frequent in the lower limbs, and have increased risk of poor short-term outcomes and longer hospital stay. We recommend an early plastic surgery review at admission of patients with degloving injuries with underlying fracture to improve the flap viability and reduce the infection risk.
Additional file 1: Management of MLL in a 25 years old female patient knocked by a truck: a. X-rays film of an unstable pelvic fracture with a left thigh MLL; b. External fixation, diverting colostomy, hematoma evacuation and compression bandage of the MLL. (JPEG 421 kb)
Additional file 2: Large degloving injury of the entire right upper limb of a 22 years old male patient; a construction worker who was trampled by a trailer. (JPEG 2499 kb)
Kudsk KA, Sheldon GF, Walton RL. Degloving injuries of the extremities and torso. J Trauma Acute Care Surg. 1981;21(10):835–9. CrossRef
Hidalgo DA. Lower extremity avulsion injuries. Clin Plast Surg. 1986;13(4):701–10. PubMed
Hak DJ, Olson SA, Matta JM. Diagnosis and management of closed internal degloving injuries associated with pelvic and acetabular fractures: the Morel-Lavallee lesion. J Trauma Acute Care Surg. 1997;42(6):1046–51. CrossRef
Latifi R, El-Hennawy H, El-Menyar A, Peralta R, Asim M, Consunji R, et al. The therapeutic challenges of degloving soft-tissue injuries. J Emergencies Trauma Shock. 2014;7(3):228. CrossRef
Solomon L, Warwick D, Nayagam S. Apley’s system of orthopaedics and fractures: CRC press; 2010. http://www.crcpress.com/Apleys-System-of-Orthopaedics-and-Fractures-Ninth-Edition/Solomon-Warwick-Nayagam/p/book/9781444113242Edition.
de Korte N, Dwars BJ, van der Werff JF. Degloving injury of an extremity. Is primary closure obsolete? J Trauma Acute Care Surg. 2009;67(3):E60–E1. CrossRef
Ma Y, Li J, Li B. Determination of the cutaneous viability of skin following incomplete avulsion and its treatment. Zhongguo xiu fu chong jian wai ke za zhi= Zhongguo xiufu chongjian waike zazhi= Chinese journal of reparative and reconstructive surgery. 1999;13(1):1–3. PubMed
Van Vugt J, Beks S, Borghans R, Hoofwijk A. The Morel-Lavallee-lesion: delayed symptoms after trauma. Ned Tijdschr Geneeskd. 2012;157(23):A5914–A.
Galukande M, Jombwe J, Fualal J, Gakwaya A. Boda-boda injuries a health problem and a burden of disease in Uganda: a tertiary hospital survey. East and central Africa Journal of Surgery. 2009. https://www.ajol.info/index.php/ecajs/article/viewFile/136999/126493.
Network TAR. Injury severity score. https://www.tarn.ac.uk/Content.aspx?c=3117; [cited 5 May 2017].
Khan AT, Tahmeedullah, Obaidullah. Degloving injuries of the lower limb. J Coll Physicians Surg Pak. 2004;14(7):416–8. PubMed
Lavoie A, Moore L, LeSage N, Liberman M, Sampalis JS. The New Injury Severity Score: a more accurate predictor of in-hospital mortality than the injury severity score. J Trauma Acute Care Surg. 2004;56(6):1312–20. CrossRef
- Degloving injuries with versus without underlying fracture in a sub-Saharan African tertiary hospital: a prospective observational study
Hervé Monka Lekuya
Ater Ngoth Deng
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II