Degloving injuries: patterns, treatment and early complications among patients at a Teaching Hospital in Western Kenya

Abstract

Background: Degloving injuries result from avulsion of extensive portion of skin and subcutaneous tissue from the underlying fascia, muscles and tendons. They commonly occur in orthopaedic surgery with accompanied blood loss, concomitant injuries and contamination. Objective: To determine the pattern, treatment, and early complications of degloving injuries. Methods: A prospective study among 48 patients admitted with degloving injuries at Moi Teaching and Referral Hospital-Kenya between 1st December 2016 and 30th November 2017. The diagnosis was made through physical examination and ultrasonography followed by photo-documentation while demographic and injury history were recorded in a questionnaire. Fisher’s exact test of association between pattern of injury and complications was conducted. Results: Median age was 26 (IQR: 18.5, 42.5) years with male to female ratio of 1.5:1. Most (75%) of the injuries were from road traffic accidents commonly (n=23) affecting the lower limbs. Open degloving injuries (n=44) either had single (n=29) or serial debridement (n=15) with the commonest definitive treatment being primary closure (n=22). Closed degloving injuries were either conservatively managed (n=2) or drained (n=2). Only 31.2% of the patients developed complications which statistically was significantly associated (p=0.002) with the patterns of degloving injury. Conclusion: Open degloving injuries affecting the lower limbs were commonest and were mainly treated through primary closure. Early complications were associated with injury patterns and treatment modality. There is need to develop institutional protocols for the treatment of degloving injuries to reduce early complications