General Surgery Tutorial

SOFT TISSUE INJURY:

AVULSION AND DEGLOVING
Soft Tissue Injury

 An injury where skin and the underlying soft

tissue is elevated from the fascia underneath by
a sudden and powerful pull (shearing force)

 Perforator blood vessels disrupted

 Avulsion

 Avulsion – sections of skin torn off either in

part (attached to body) or totally (detached from
body); heavy bleeding is common1

1Austin JC. Hand Infections, Compartment Syndrome, and High-Energy Injuries. In: Brown
DL, Borschel GH. Michigan Manual of Plastic Surgery. Philadelphia: Lippincott Williams &
Wilkins; 2004. 1st ed.
 Degloving Injury

 Degloving – injuries
involving extensive skin
and soft tissue loss with
variable amounts of
contamination due to
shearing force
 Types
 Closed: skin intact
 Open: skin continuity
disrupted
2Sen CK, Roy S. Wound Healing. In: Plastic Surgery Principles.
 Examination

 Physical examination
 Radiographic examination
 Vitality test

Degloving injuries of the hand, Indian J Plast Surg. 2011 May-Aug; 44(2): 227–236.
Vitality Test

Split Thickness
Skin Excision
(STSE)

Fluorescein Test
 Split Thickness Skin Excision (STSE)

 A sequential and layered excision of devitalized

tissues to a vital wound bed  punctuate
bleeding
 Inadequately excised wound is more likely to
become infected and is unsuitable for flap or
skin graft take  further surgery

Rennekampff HO, Tenenhaus M. Debridement of the Burn Wound. In: Hyakusoku H,

Orgill DP, Teot L, Pribaz JJ, Ogawa R. Color Atlas of Burn Reconstructive Surgery.
Springer; 2010.
Management Principles

 ABC  control bleeding

 Tetanus prophylaxis and i.v. antibiotics
 Emergent irrigation and debridement in the OR
 Protect underlying structures from desiccation
 Soft tissue coverage performed once wound is
clean
 Early adequate debridement  earlier soft
tissue coverage  better long-term outcome
 Skin and Soft Tissue Trauma

Degloving Avulsion

Closed Open

Tissue Vitality Test

Vital
Nonvital Vital Nonvital
Small Incision

Excision Loose Adequate Inadequate

Irrigation
Suture Skin Skin
Drain STSG
STSG Defatting Excision
Compression
FTSG STSG
Ziv I, Zeligowski A, Mosehiff R, Lowe J, Wexler MR, Segal D. Split Thickness
Skin Excision in Severe Open Fractures. J Bone Joint Surg Br. 1988 Jan;70(1):23-
6.
Complications

 Infection
 Graft lysis
 Flap necrosis
Thank You 