The Degloving Injury

Avulsion of skin from the hand or fingers is an injury that has a dramatic presentation. The entire musculo-skeletal unit of the finger is intact, and the patient can often move the parts of his naked hand quite normally. When the skin of the affected part has been totally removed, exposing the underlying structures, it is referred to as complete or anatomical degloving. The challenge for the reconstructive surgeon lies in resurfacing the hand or finger with a good quality pliable sensate skin cover while preserving the movements and function of the hand. The avulsion of skin from the underlying structures is usually a result of trauma. A degloving injury attains more significance in the hand because of the irreplaceable quality of the skin. 

These injuries occur when the hand is caught by a force and pulled at a low velocity. The force that holds the skin usually has some amount of irregular surface, that holds on to the skin preventing slip. In road traffic accidents, the usual mode of injury is the tire of the vehicle running over the outstretched hand and forearm. In industrial accidents, there are two types of machines that can cause an outward force on an entangled hand — the conveyor belt and the roller machine. Another common cause of degloving injury involves a single finger. When a person is wearing a ring, and the hand is moving quickly in a specific direction, and the ring gets caught by a sudden stopping force, a ring avulsion injury occurs.

Thumb degloving injury - first degree

Thumb degloving injury - second degree

Finger degloving injury - first degree

Finger degloving injury - second degree

Finger degloving injury - third degree

Full hand degloving injury