The Underreported Benefits of Surgical Intervention for Chronic Sequelae of Closed Degloving Injuries: A Case Series
1From the Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA.
Background:
Chronic closed degloving injury (CCDI) symptoms may result from fibrous capsule formation or traumatic fat displacement, often leading to contour deformity and debilitating pain. Although minimally invasive therapies are common first-line treatments, limited data exist on definitive management.
Methods:
A retrospective review identified 7 patients who underwent surgery for CCDI more than 2 months postinjury during a 3.8-year period. The analysis includes patient demographics, injury characteristics, outcomes of contour correction, symptom relief, and complications.
Results:
All patients presented with contour deformity, and 6 reported pain. Capsulectomy was the most frequently performed procedure (71%, n = 5). No patients had clinically significant residual fluid more than 5 cm3 within a capsule. Among those who underwent capsulectomy, 40% (n = 2) reported significant improvement and 60% (n = 3) achieved complete pain resolution with restored function. Two patients who underwent lipectomy alone sought correction of contour deformity without significant pain complaints. Of all contour deformities, 67% (n = 6) fully resolved, 11% (n = 1) improved, and 22% (n = 2) persisted.
Conclusions:
Significant preoperative pain was associated with the presence of a fibrous capsule despite the resolution of fluid collection. Not previously discussed in the literature, the involvement of large sensory nerves at the Scarpa or muscle fascia plane may help explain the degree of pain and subsequent relief. Surgical management was highly effective in addressing pain, neuropathy, and soft-tissue deformity associated with CCDI. These findings support surgery as a definitive treatment option for CCDI symptoms.
