How To Treat an Avulsion or Degloving

Avulsions are severe traumatic injuries in which one or more pieces of tissue are torn and detached from the body, including at least all three layers of skin. These injuries are much more extensive than lacerations (cuts), but they are less substantial than traumatic amputations (a finger or limb is completely cut from the body).

Avulsions are devastating injuries, and they come with a high degree of infection risk—similar to burns. They are commonly caused by animal bites, industrial equipment injuries, or motor vehicle accidents (especially motorcycles).

Avulsion or Degloving

An avulsion injury extends through all the layers of skin. You may be able to lift up a flap of tissue that is still connected, or the tissue could be completely detached from the body. If the section of avulsed tissue is available, it can sometimes be repaired.

If the avulsed tissue is not available, the injury is often treated like a burn, in which layers of skin have been severely damaged or lost.

Degloving

An avulsion that wraps all the way around an extremity and causes the layers of tissue to pull away is called a degloving injury. Imagine peeling a glove off your hand so that it ends up inside-out. That's where the term comes from.

Degloving can affect any part of the body, such as the fingers, feet, or hands. A common cause of degloving injury is when a ring catches on something, resulting in a degloving injury of the finger. Some degloving injuries eventually result in surgical amputations.

List of Common Avulsion Injuries and Sites

An avulsion injury can happen in different areas of the body, with avulsion fractures being the most commonly described avulsion injuries. The injury involves traumatic detachment of any piece of tissue, which can include bone, cartilage, tendon, ligament, and/or skin and fat.

Examples include:

• Avulsion fracture, such as tibial avulsion fracture
• Avulsion fracture of a metatarsal (toe bone)
• Ring avulsion injury from a wedding band
• Tendon avulsion, such as triceps tendon avulsion
• Muscle avulsion, such as proximal adductor avulsion
• Eye injury, such as choroidal (a layer in the back of the eye) avulsion

An avulsion injury will usually cause severe pain and bleeding. Sometimes, due to the extent of the injury, nerves may be damaged, which can prevent a person from feeling pain.

Medical Care

If you or someone else experiences an avulsion injury, seek immediate medical attention by going to an emergency room or urgent care clinic. Avulsion injuries will almost always need medical care, and will often need surgical intervention.

The care for an avulsion will include immediate steps as well as ongoing management that may continue for several months until healing is complete.

You might need antibiotic treatment and/or vaccinations to prevent an infection. Infection prevention will depend on the type of injury. Animal bites, for example, pose a high risk of infection.

Steps to Treat an Avulsion

The person with the avulsion injury will need immediate medical care, but these first aid steps can be done as soon as possible, even before medical treatment is available.

Stay safe: If you are not the person who was injured, practice universal precautions and wear personal protective equipment if available. Stay clear of whatever caused the injury and only attempt to help if it is safe to do so. You will not be of any help if you are injured while trying to save someone else.

Control bleeding with direct pressure and elevation: Use an absorbent clean dressing or whatever clean cloth is available to hold pressure on an open avulsion or degloving injury. The dressing will trap blood and hold it against the open wound, promoting clotting. Clotting will ultimately help to stop the bleeding.

Avoid tourniquets unless bleeding cannot be controlled and medical care will not be available for several hours.

Do not be afraid to put direct pressure on raw muscle or fat tissue. Even though the wound is open and raw, direct pressure is the best way to stop bleeding.

Rinse the wound: Use water or saline solution. The cleaner the wound, the better. Sterile irrigation is the best. This will restart the bleeding in many cases, and that's OK as long as the bleeding is minimal.

If the bleeding was very difficult to stop and you are concerned that it will be out of control if you rinse the wound, then skip this step while you are waiting for professional help.

Replace the flap or bring separated tissue to the hospital: If the tissue (skin, fat, and muscle) is not completely torn away, replace the flap and cover the wound. If the tissue is completely separated from the person's body, collect it if it's available and bring it to the emergency department.

Healing From an Avulsion

It takes time to heal from an avulsion injury. During your recovery, you may need frequent visits to your healthcare provider for dressing changes and examination of the wound to assess for any complications, such as an infection.

You may also have instructions regarding activity limitations to avoid movements that could interfere with your healing.