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