Degloving injuries of the extremities and torso

Degloving injuries of the extremities and torso occur with relative frequency and are associated with a high morbidity and mortality. The common aim of all surgical approaches is to reestablish skin coverage over the injured area, but therapies differ in both technique and results. This survey evaluates the management and results of 21 patients sustaining degloving injury of at least 2/3 the circumference of the torso or an extremity. Initial surgical techniques which employ application of the skin as a full- or split-thickness graft were contrasted with those in which salvage of the entire flap with its subcutaneous tissue was attempted. The results suggest that immediate use of the degloved skin as a full-or split-thickness skin graft gives the most satisfactory coverage to the denuded areas. Other important features in management include frequent observation and immobilization of the extremity postoperatively, and use of mesh grafts when necessary to cover large areas. Recent emphasis on the blood supply of the skin underscores the importance of its circulation as the determinant of flap survival. Daily observation until the flap becomes fixed is mandatory. Primary reattachment of the full-or split-thickness flap by suture or use of compression dressings without grafting is unsuccessful and should be abandoned as an acceptable approach to this problem.