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Degloving

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Degloving

Degloving occurs when skin and the fat below it, the subcutaneous tissue, are torn away from the underlying anatomical structures they are normally attached to. Normally the subcutaneous tissue layer is attached to the fibrous layer that covers muscles known as deep fascia.

A degloving injury is a type of soft-tissue avulsion injury that can occur anywhere in the body. Commonly affected areas include the face, scalp, trunk, limbs, and genitalia. Degloving injuries are caused by shearing forces that cause the soft tissue layers to get pulled apart. They were first reported in the twentieth century from machinery such as wringers used to dry clothes. The invention and widespread use of automobiles also lead to degloving and other traumatic injuries.

Degloving injuries can be categorized as either open or closed. Closed injuries are not open to the external world and the underlying structures are not visible. In open injuries, the skin is torn back so that the underlying structures are visible. Such an injury could thus resemble the process of removing a glove from a hand.

The treatment of a degloving injury requires assessment of the damage to the soft tissue and associated blood vessels. Any soft tissue that is dead must be removed. If the soft tissue that was torn away is healthy and has a blood supply, it can be used in the treatment. Replantation and revascularization are when the soft tissue that was torn away is reattached with proper blood flow. In cases where reattachment can't occur, skin flaps or skin grafting may be done.

The term Morel-Lavallée lesion is an eponym for a closed internal degloving injury. The injury is named after a French physician who first described the injury.

A closed internal degloving injury is a separation between the layers of soft tissue which creates a space that is internal and closed off from the outside world. The new space acts as a pocket with the potential to fill with fluids.

The injury occurs due to trauma that results in a shearing force. This force causes the layer of fat below the skin, the superficial fascia, to separate from the deep fascia and muscle beneath. This separation also damages blood and lymphatic vessels. Blood and lymphatic fluid can then fill the space that was created. During healing, the breakdown of the red blood cells can create inflammation. The inflammation can be chronic and lead to the formation of a fibrous capsule. The fibrous capsule is a layer that covers the inside of the lesion. This layer isn't normally present and is the body's response to the inflammation. The formation of a capsule prevents any absorption of fluids that would occur during the healing process.

Morel-Lavallée lesions are a result of traumatic injuries such as high-energy motor vehicle crashes, or crush injuries. Blunt force injuries, even at lower velocities, such as falls, bicycle accidents, or sports injuries also result in the injury. Instances of Morel-Lavallée lesions post-operatively after liposuction and abdominoplasty have also occurred.

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