DOI: 10.1097/TA.0b013e31803420be

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PMID: 19820564

Issn Print: 0022-5282

Publication Date: 2009/10/01


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Novel Management of Closed Degloving Injuries

Melanie Morris; Martin A. Schreiber; Bruce Ham

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Excerpt

Degloving injuries result from a shearing force applied to the skin surface, which causes separation of the skin and subcutaneous tissue from the underlying muscle and fascia. These injuries create a potential space allowing accumulation of fluid. Extensive injuries frequently require surgical drainage and prolonged use of closed suction drains. Most of the degloving injuries seen today involve the torso or lower extremities and are caused by entrapment between a fixed surface and a moving object such as a spinning automobile tire. Others occur when patients are thrown across a fixed surface or injured during extrication.1 The shearing forces applied during injury disrupt perforating vessels at the fascial level, which may lead to skin necrosis if the blood supply is not adequate. These injuries are frequently associated with fractures and other life-threatening injuries.
Vacuum-assisted closure (VAC) has been well described in treating both acute and chronic wounds. Since its introduction, the indications for wound VAC therapy have greatly expanded. It is now applied to contaminated wounds, burns, envenomations, infiltrations, and wound complications from failed operations.2 This therapy has also been applied to open degloving injuries, both as a primary treatment and as a dressing over skin grafts.3,4 We present the initial report of a novel use for wound VAC therapy in an extensive closed degloving injury.
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