Patterns, treatment and early complications of degloving injuries in patients managed at Moi Teaching and Referral Hospital

Abstract

Background: Degloving injuries are a form of avulsion of soft tissue in which an extensive portion of skin and subcutaneous tissue detaches from the underlying fascia and muscles. These injuries are common among Orthopedics patients and the treatment is compounded by blood loss, concomitant injuries, and contamination. There is a paucity of data on patterns, treatment modalities, and complications of degloving injuries. Objective: To determine the pattern, treatment, and early complications of degloving injuries in patients managed at Moi Teaching and Referral Hospital (MTRH). Methods: A prospective descriptive study was conducted at Moi Teaching and Referral Hospital between 1st December 2016 and 30TH November 2017. This was a census study where all 48 patients admitted with degloving injuries who met the inclusion criteria were included in the study. Diagnosis of open degloving injuries was made through physical examination while closed degloving injuries were made through both physical examination and confirmed by the use of ultrasound. After informed consent, a researcher administered questionnaire was used to collect data on demographics, mechanism of injury, time from injury to hospital, and location of injury. At the time of wound exposure and assessment, photo-documentations was done. Patients were followed up from the time of admission up to 30 days after definitive management. Those who were discharged before 30 days after definitive treatment were seen in outpatient clinic. Data on treatment modalities and complications was obtained during the follow-up period. Fisher’s exact test was used to test for association between the presence of complications and various treatment modalities. Confidence level was set at 95%. Results: There were 48 patients recruited into the study. The male to female ratio was 1.5: 1. The median age of the patients was 26 IQR (18.5, 42.5). Forty-four patients (92%) had acquired primary or secondary education. Motor vehicle and motorcycle accidents contributed to 75% of the injuries. Lower limbs were involved in 23 (47.9%) patients. Open degloving injuries comprised the majority (92%). Noncircumferential involvement was seen in 26 (59.1%) patients. All patients with open degloving injuries (n=44) underwent either single debridement (n=29) or serial debridement (n=15). Definitive treatment modalities for open degloving injuries included primary closure (n=22), split-thickness skin graft (n=10), full-thickness skin graft (n=7), muscle flap (n=5) while for closed degloving injuries included conservative management (n=2), and drainage (n=2).Complications were observed in 15 (31.2%) patients. Of the patients who developed complications, 40% had local wound infection. Other complications included skin graft failure (20%), massive hemorrhage (26.7%), and primary flap necrosis (13.3%). There was a significant association (p=0.002) between the patterns of degloving injuries and the presence of complications. Conclusion: Most degloving injuries occurred among young males. Most degloving injuries were open and affected the lower limb. The main treatment modalities were primary closure and skin grafting. Local wound infection was the main early complication. There was an association between the need for serial debridement and complications. Recommendations: Development of an institutional protocol for the treatment of degloving injuries to reduce complications