title: Patterns and management of degloving injuries: a single national level 1 trauma center experience.
abstract: BACKGROUND
  Degloving soft tissue injuries (DSTIs) are serious surgical conditions. We aimed to evaluate the pattern, management and outcome of DSTIs in a single institute.
  
  
  METHODS
  A retrospective analysis was performed for patients admitted with DSTIs from 2011to 2013. Presentation, management and outcomes were analyzed according to the type of DSTI.
  
  
  RESULTS
  Of 178 DSTI patients, 91 % were males with a mean age of 30.5 ± 12.8. Three-quarter of cases was due to traffic-related injuries. Eighty percent of open DSTI cases were identified. Primary debridement and closure (62.9 %) was the frequent intervention used. Intermediate closed drainage under ultrasound guidance was performed in 7 patients; however, recurrence occurred in 4 patients who underwent closed serial drainage for recollection and ended with a proper debridement with or without vacuum assisted closure (VAC). Closed DSTIs were mainly seen in the lower extremity and back region and initially treated with conservative management as compared to open DSTIs. Infection and skin necrosis were reported in 9 cases only. Open DSTIs were more likely involving head and neck region and being treated by primary debridement/suturing and serial debridement/washout with or without VAC. All-cause DSTI mortality was 9 % that was higher in the closed DSTIs (19.4 vs 6.3 %; p = 0.01).
  
  
  CONCLUSIONS
  The incidence of DSTIs is 4 % among trauma admissions over 3 years, with a greater predilection to males and young population. DSTIs are mostly underestimated particularly in the closed type that are usually missed at the initial presentation and associated with poor outcomes. Treatment guidelines are not well established and therefore further studies are warranted.
authors.affiliation: Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
authors.forename: Suhail
authors.initials: S
authors.lastname: Hakim
authors.affiliation: Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
authors.forename: Khalid
authors.initials: K
authors.lastname: Ahmed
authors.affiliation: Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
authors.forename: Ayman
authors.identifier: 0000-0003-2584-953X
authors.initials: A
authors.lastname: El-Menyar
authors.affiliation: Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
authors.forename: Gaby
authors.initials: G
authors.lastname: Jabbour
authors.affiliation: Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
authors.forename: Ruben
authors.initials: R
authors.lastname: Peralta
authors.affiliation: Department of Radiology, Hamad General Hospital, Doha, Qatar.
authors.forename: Syed
authors.initials: S
authors.lastname: Nabir
authors.affiliation: Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
authors.forename: Ahammed
authors.initials: A
authors.lastname: Mekkodathil
authors.affiliation: Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
authors.forename: Husham
authors.initials: H
authors.lastname: Abdelrahman
authors.affiliation: Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
authors.forename: Ammar
authors.initials: A
authors.lastname: Al-Hassani
authors.affiliation: Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Thani
keywords: Debridement; Degloving; Management; Soft tissue injury; Trauma