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Plastic SurgeryEmergency

Degloving Injury Management

Degloving Injury Management: Degloving Injury → Types of Degloving → Arnez Classification → Viability Assessment → Initial Management.

Pathway Overview

11 steps

Algorithm Steps

11 total

  1. 01Start

    Degloving Injury

    Traumatic separation of skin from fascia

  2. 02Action

    Types of Degloving

    Open vs Closed

    • OPEN DEGLOVING:
    • - Visible skin separation
    • - Skin may be attached or avulsed
    • - Common: Extremities, fingers
    • CLOSED DEGLOVING (Morel-Lavallée):
    • - Skin intact externally
    • - Internal shearing of fascia
    • - Collection of blood/lymph
    • - Often missed on initial exam
    • - Common: Thigh, pelvis, trunk
  3. 03Action

    Arnez Classification

    Open degloving severity

    • PATTERN 1: Abrasion/Limited degloving
    • - Skin loss <100 cm²
    • - Usually heal with conservative care
    • PATTERN 2: Non-circumferential degloving
    • - Larger area, one plane preserved
    • - May reattach or graft
    • PATTERN 3: Circumferential single-plane
    • - Complete circumferential injury
    • - Significant vascular compromise
    • PATTERN 4: Circumferential multi-plane
    • - Muscle, nerve, vessel exposure
    • - Worst prognosis
  4. 04Action

    Viability Assessment

    Determine what can be saved

    • CLINICAL SIGNS:
    • - Color (pink vs pale vs dusky)
    • - Capillary refill
    • - Dermal bleeding on incision
    • - Turgor
    • ADJUNCTS:
    • - Fluorescein test (1g IV, Wood's lamp)
    • - Laser Doppler
    • - ICG angiography
    • TIMING:
    • - Assess at 24-48h (more accurate)
    • - Serial reassessment
  5. 05Warning

    Initial Management

    Emergency care

    • RESUSCITATION:
    • - Large blood loss common
    • - Associated injuries (fractures)
    • WOUND CARE:
    • - Copious irrigation
    • - Debride necrotic tissue
    • - Preserve questionable tissue initially
    • - Tetanus, antibiotics
    • TEMPORIZING:
    • - Moist dressings
    • - VAC therapy
    • - Keep degloved skin (may use as graft)
  6. 06Decision

    Treatment Based on Viability

    Viable vs Non-viable skin

  7. 07Action

    Viable Degloved Skin

    Attempt to save

    • REPLANTATION OPTIONS:
    • - Primary reattachment if circulation OK
    • - Quilting sutures to prevent seroma
    • - Drain placement
    • - VAC over flap
    • MONITORING:
    • - Serial exam for viability
    • - Be prepared for failure
  8. 08Action

    Definitive Reconstruction

    Coverage options

    • GRAFTS:
    • - FTSG from degloved skin (ideal)
    • - STSG from donor site
    • FLAPS (if needed):
    • - Local flaps
    • - Regional pedicled flaps
    • - Free flaps for large defects
    • TIMING:
    • - Early closure reduces infection
    • - Wait for clean granulating bed
  9. 09Outcome

    Outcomes

    Expected results

    • Functional recovery variable
    • Sensation usually impaired
    • Cosmesis often suboptimal
    • Multiple revision surgeries common
    • Ring degloving: High amputation rate
    • Long-term PT/OT needed
  10. 10Action

    Non-Viable Degloved Skin

    Salvage skin for grafting

    • FULL-THICKNESS GRAFT HARVEST:
    • - Harvest FTSG from avulsed skin
    • - Defat carefully
    • - Store in saline (refrigerate)
    • - Bank for delayed grafting
    • WOUND BED PREPARATION:
    • - Serial debridement
    • - VAC therapy for granulation
    • - Usually 7-14 days before grafting
  11. Path rejoins step 08Shared downstream outcome
  12. 11Action

    Morel-Lavallée Lesion

    Closed degloving management

    • DIAGNOSIS:
    • - Fluctuant swelling
    • - MRI confirms collection
    • - May present days later
    • TREATMENT OPTIONS:
    • - Aspiration + compression (small)
    • - Percutaneous drainage (larger)
    • - Open debridement (organized)
    • - Sclerosing agents (talc, doxycycline)
    • HIGH RECURRENCE RATE
  13. Path rejoins step 08Shared downstream outcome

Guideline Source

Degloving Injury Management Consensus

DOI: N/A

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Viability assessment challenging
  • Hidden degloving (Morel-Lavallée) easily missed
  • Multiple surgeries often required
  • Significant morbidity even with treatment

Applicable Regions

USEU
Version 1Next review: 2027-01-11

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Frequently Asked Questions

What is the Degloving Injury Management?

The Degloving Injury Management is a emergency clinical algorithm for Plastic Surgery. It provides a structured decision tree to guide clinical decision-making, based on Degloving Injury Management Consensus.

What guideline is the Degloving Injury Management based on?

This algorithm is based on Degloving Injury Management Consensus (DOI: N/A).

What are the limitations of the Degloving Injury Management?

Known limitations include: Viability assessment challenging; Hidden degloving (Morel-Lavallée) easily missed; Multiple surgeries often required; Significant morbidity even with treatment. Individual patient factors may require deviation from these recommendations.

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