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Corresponding author:
Kyriakidis Alexandros
Frouriou 95, 33100.
Amfissa.
Tel.number:22650-72265.
Fax number: 22650-22086.
E-mail:alkidi@hotmail.com
Abstract
Key words
Degloving injuries cause stripping of skin and underlying tissues from the
bones, usually of the hands or feet as occurs in run-over accidents, wringer or
industrial roller injuries. [3, 22, 46, 48] These three cases of degloving injury of the
lower limb and the fourth finger of the right hand respectively are presented in
order to describe this rare and potentially very serious injury of soft tissue.
Case reports
The skin is the most extended organ of the human organism. It has a
multifunctional role (excretory, protective, temperature-regulatory, and
sensory) which gives a high level of importance in case of skin injury. Skin can
be damaged in the following ways: direct trauma, stretching, degloving and
undermining during an operation. [44,5,42,45] If a limb is caught firmly and pulled
violently at the moment of impact, the skin may be peeled back over
underlying tissues, most often bones, for a considerable distance perhaps
over the whole leg or forearm. These injuries are called “degloving” injuries
but the same problems, as in degloving injuries, can arise just by stripping the
skin off the underlying tissues without being rolled back like glove (common in
fractures of the tibia and fibula). [18,36,41] In the hand or arm it is commonly
caused by the limb being crushed between rollers, while in the leg it may
result from the shearing effect of a vehicle wheel passing over the limb in a
run-over accident.Degloving tissue injuries can interrupt large vessels and the
continuity of capillary beds. [8, 11, 17] Edema soon forms’, increasing the distance
oxygen needs to diffuse from functioning capillaries. Any injured tissue swells
and must have room to expand if there is no room for expansion the tissue will
become ischaemic.This often creates a vicious circle, causing complications
such as compartment syndrome (a condition in which pressure within a
confined space results in tissue ischemia and resulting dysfunction) and frank
sloughing of compromised tissue. [1, 37, 2, 28]
The skin may remain unbroken, in which case the limb feels like a fluid-
containing bag, owing to the presence of an extensive haematoma between
the skin and the fascia (compartment syndrome). [20, 24, 14, 32]If the skin is torn,
the effect is the creation of a large flap of full-thickness skin. In either case,
massive sloughing is likely unless the injury is properly managed. [10, 7, 15]
Depending on the type of skin or tissue damage a number of plastic surgical
techniques are possible for tissue repair:
Conclusions
Degloving injury is very serious and potentially dangerous soft tissue lesion. It
completely destroys normal skin and underlying soft tissue rendering the
human organism defenseless and vulnerable to soft-tissue necrosis and
consequently to numeral life-threatening infections. The presented cases
illustrate the magnitude of injury in degloving injuries to the lower extremity
and the variety of techniques that can be used in reconstruction. Treatment
depends on the time of detection and the extend of tissue injury .In early
stages and good soft-tissue condition, after de-fatting of damaged skin,
immediate re-appliance of a full thickness graft is the treatment of choice. If
delay is substantial, because of contamination and inflammation of the
surrounding tissue, advice and possible treatment from an experienced plastic
surgeon is highly desirable.
Bibliography