title: Classification of soft-tissue degloving in limb trauma.
abstract: Compressive, tortional and abrasive deforming forces are translated to the limbs during high energy trauma. The long bones may be fractured in many patterns with a varying extent of fragmentation and comminution but the soft-tissues appear to absorb the forces in a predictable way. We retrospectively reviewed a series of 79 complex limb injuries treated in a dedicated centre where the clinical notes and photo-documentation were meticulously kept and where the outcomes were known. The soft-tissue injuries were then described and revealed four patterns of injury: abrasion/avulsion, non-circumferential degloving, circumferential single plane and circumferential multi-plane degloving. These patterns occurred either in isolation or occasionally in combination. Resuturing of degloved skin was only successful in non-circumferential (pattern 2) cases. Radical excision of devitalised tissue followed by soft-tissue reconstruction in a single procedure was successful in all patterns apart from pattern 4 (circumferential multi-plane degloving). In pattern 4 we recommend serial wound excision prior to reconstruction.
authors.affiliation: Ospedali Di Cattanara, Strada di Fiume, 447-34149, Trieste, Italy.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Arnez
authors.forename: U
authors.initials: U
authors.lastname: Khan
authors.forename: M P H
authors.initials: MP
authors.lastname: Tyler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006230:Hand Injuries / Q000145:classification* / Q000175:diagnosis; D006801:Humans; D007869:Leg Injuries / Q000145:classification* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000145:classification* / Q000175:diagnosis; D015599:Trauma Severity Indices; D055815:Young Adult