What it is

Open vs closed

• Open degloving: skin is torn away and underlying structures are visible (e.g. a finger avulsion injury with skin loss).
• Closed degloving: skin remains intact over the top but is sheared from the fascia beneath, usually from a shearing/torsion force (classic mechanism: motor vehicle run-over or wheel entrapment). This is easy to underestimate because the skin surface can look deceptively normal.
• When a closed shearing injury creates a fluid-filled potential space (blood + lymph) between fascia and subcutaneous fat, it's called a Morel-Lavallée lesion - classically over the greater trochanter/hip and thigh, but now described at other sites too.

Classification (limb trauma)

1. Limited degloving with abrasion or avulsion
2. Non-circumferential degloving
3. Circumferential, single-plane degloving
4. Circumferential, multiplanar degloving

Assessing tissue viability

• Fixed staining (discoloration that does not blanch with digital pressure)
• Thrombosis of subcutaneous veins
• Failure of punctate dermal bleeding on incision

Management principles

• Resuscitate and treat as a high-energy polytrauma patient until proven otherwise (associated fractures, vascular injury are common).
• Serially excise clearly non-viable skin until punctate dermal bleeding confirms viable tissue at the margins.
• Circumferentially degloved skin is almost always non-viable and typically requires excision.
• Reconstructive options once debrided: meshed split-thickness skin graft (if bone/fracture not exposed) or flap coverage (local/free myocutaneous flap) if bone or fracture site is exposed. Negative-pressure wound therapy (NPWT) is often used short-term to help graft take, especially over irregular wound beds.
• Special/high-risk sites: degloving over bony prominences (e.g. malleoli) or the heel/calcaneus is particularly problematic because there's little tissue reserve and specialized skin (heel pad) cannot be well replaced.
• In upper-limb degloving specifically, options include salvage of the degloved segment via microsurgical revascularization (direct arterial anastomosis or AV shunting) versus reconstruction of the unsalvageable segment.

Evidence check

• It disrupts the perforating blood vessels and lymphatics that run between fascia and skin, so the skin often becomes non-viable even if it looks intact on the surface.
• It can be open (skin torn away, underlying structures visible - e.g. a finger avulsion with skin loss) or closed (skin surface stays intact but is sheared off the fascia beneath, typically from a shearing/torsion mechanism such as a motor vehicle run-over or wheel entrapment).
• When a closed shear injury creates a blood/lymph-filled space between the fascia and subcutaneous fat, that specific entity is called a Morel-Lavallée lesion.

1. Limb trauma degloving classification (4 grades)

1. Limited degloving with abrasion or avulsion
2. Non-circumferential degloving
3. Circumferential, single-plane degloving
4. Circumferential, multiplanar degloving

• Single-plane degloving occurs between the subcutaneous fat and the deep fascia.
• Multiplanar degloving extends further, occurring within muscle groups and between bone and muscle.
• Skin non-viability risk increases progressively from grade 1 to grade 4 - circumferential and multiplanar injuries carry the highest risk of non-viable skin because they disrupt more of the perforating vascular supply.

2. Open vs. closed (overarching category)

• Open degloving: skin is torn away and the underlying structures are visible (e.g. a finger avulsion injury with skin loss).
• Closed degloving: the skin surface remains intact, but is sheared away from the underlying fascia - typically from torsion, avulsion, or crush forces (classic mechanism: motor vehicle run-over, wheel entrapment). This type is more dangerous because the extent of non-viable tissue is easy to underestimate on visual inspection.

Related site-specific classification (fracture context)