Definition
- Avulsion of skin and subcutaneous fat from the underlying fascia by shear
- Open degloving from wheel and machinery injuries
- Closed degloving forms a Morel-Lavallée lesion, often over the greater trochanter or thigh
- Degloving of the hand and fingers occurs with ring avulsion injuries
- Severity is often underestimated at first presentation
Clinical Features
- Skin may look intact but be non-viable
- Fluctuant swelling and hypermobile skin in closed lesions
- Associated pelvic and acetabular fractures
- Skin with poor capillary refill, dark colour or no bleeding at the edge is non-viable
- Closed lesions can present days to months after injury
Investigations
- Assess flap viability by dermal bleeding or fluorescence angiography
- MRI or ultrasound for closed lesions
- CT for associated fractures
- Serial examination over 24 to 48 hours as demarcation develops
Management
- Open degloving, excise non-viable skin and defat it for use as a skin graft
- Negative pressure wound therapy
- Closed small lesions, compression or aspiration
- Closed large lesions, debridement and drainage, or sclerodesis
- Treat the Morel-Lavallée lesion before fixing fractures through it, as infection risk is high
- Early plastic surgery involvement
- Serial debridement until the wound is clean
- Free tissue transfer for exposed bone, tendon or implants
- Tetanus prophylaxis and antibiotics for open injuries
Complications
- Flap necrosis and infection
- Seroma and pseudocyst formation in closed lesions
- Contour deformity and chronic pain
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.