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.

The treatment of a degloving injury requires assessment of the damage to the soft tissue and associated blood vessels.

[1] Replantation and revascularization are when the soft tissue that was torn away is reattached with proper blood flow.

[4][5] The development of signs and symptoms that clinically indicate a Morel-Lavallée lesion can occur quickly or slowly.

The clinical presentation time frame ranges from hours to days after an injury and in some cases months to years.

[7][8] Visually, the area of the injury may have obvious signs or appear normal externally despite underlying damage.

Damage to the skin can show up as the following signs:[4][7][8][9] Fluid that fills the new space can be a part of the clinical presentation.

[4][8] Delayed presentation shows up as a painful swelling and stretching of the skin that slowly enlarges over time.

[6][7] Morel-Lavallée lesions can occur anywhere in the body, but the most common areas are the knee, hip, and thigh.

[7] The lesions generally form in areas of the body where the skin is more easily detached from the muscle.

The diagnosis of a Morel-Lavallée lesion can be made based from clinical observations or medical imaging.

Ultrasound imaging can help confirm a clinical diagnosis by visualizing the location of the lesion.

[5] Computed tomography (CT) is important in settings of an emergency or when magnetic resonance imaging is not available.

[7] The use of contrast can also help determine if fluid present in a lesion is due to active bleeding.

[5] These factors include the following: the shape of the lesion, specific MRI features, and whether a capsule is present.

The goal of treating a Morel-Lavallée lesion is to close the space that was created between the superficial and deep fascia.

[6] This can then allow for the natural formation of fibrous adhesions between the layers and closing of the space to occur more easily.

[8] Minimally invasive treatment includes medical procedures that access the space through the skin to remove fluid and promote healing.

[8] A Morel-Lavallée lesion with a lot of fluid present might need minimally invasive treatment.

Ultrasound or CT imaging can be used to visualize the area beneath the skin when performing the aspiration.

[4][6] Fibrosis occurs because the agents lead to inflammation and growth of cells called fibroblasts.

[4][6] Promoting adhesion with sclerosing agents can also prevent fluid from recurring once the space is closed.

[4][5] Open surgery is required in Morel-Lavallée lesions that are large and have extensive damage to the soft-tissues.

[6] Patients with skin that has died, necrosed, will often need the dead tissue cut out by a surgeon.

[7] Skin grafting and flap procedures use the patient’s own healthy soft tissues to heal a wound.

[7] Specific suturing techniques, progressive tension or quilting, can also be used to pull the layers closer together using stitches.