Missed closed degloving injuries: late presentation as a contour deformity

Closed degloving injuries are uncommon, and the diagnosis may be missed at the time of acute trauma. This study reports on seven patients seen during a 5-year period who presented with a contour deformity a number of months after the initial closed degloving injury. The median time to presentation was 1.4 years. In five of the seven patients, the contour deformity was present on the lateral thigh, and in two patients it occurred on the calf. Liposuction was employed to treat five patients, and all these patients reported an improvement in the contour of their limb. In two patients, because of an irregular, gritty deformity, liposuction was unsuccessful, and an open approach was required. The closed degloving injury with a contour deformity usually follows a pedestrian-motor vehicle accident. These patients present months later requesting corrective cosmetic surgery. Liposuction will improve the silhouette in most patients, but an open approach may be required where fat necrosis and heterotopic calcification have occurred.