De-gloving injury refers to_____?

Correct Answer: A. Skin and subcutaneous fat are stripped from the underlying fascia

De-gloving injury is a specific traumatic injury pattern where the skin and subcutaneous tissue (including fat) are forcibly separated from the underlying fascia, creating a plane of cleavage between the dermis-subcutaneous layer and the fascia. This injury typically occurs from high-velocity crush injuries, avulsion mechanisms, or severe friction trauma—common in Indian road traffic accidents, industrial machinery entrapment, or agricultural injuries. The critical discriminating feature is that the separation occurs at the fascial plane, leaving the fascia intact but devoid of its overlying soft tissue coverage. This creates a large cavity prone to hematoma, seroma, and infection. The viability of the degloved skin flap depends on the extent of vascular disruption; if the blood supply remains intact through the subcutaneous pedicle, replantation may be possible. Management involves careful assessment of tissue viability, debridement of devitalized tissue, and reconstruction—often requiring skin grafting or flap coverage. The fascia remains as a structural barrier, which is why option A correctly defines the anatomical plane of injury.

Why the other options are wrong

B. Skin, subcutaneous fat and fascia are stripped from tendons — This describes a deeper injury plane involving loss of fascia and exposure of underlying tendons. While severe de-gloving can extend to involve fascia and deeper structures, the defining de-gloving injury stops at the fascial plane. This option overestimates the depth of tissue loss in a classic de-gloving injury and conflates it with more extensive avulsion injuries. NBE trap: students who think 'more severe = more layers' may choose this. C. Skin, subcutaneous fat, fascia and tendons are stripped from bone — This describes a full-thickness avulsion or degloving with exposure of bone—an even more severe injury. While such injuries can occur, they represent extensive tissue loss beyond the classic de-gloving definition. Choosing this reflects confusion between de-gloving (fascial plane separation) and complete soft tissue avulsion. This is a distractor for students who conflate severity with definition. D. Only skin is stripped off — This is too superficial and describes a simple skin abrasion or partial-thickness laceration, not a de-gloving injury. De-gloving inherently involves loss of subcutaneous tissue as well as skin. This option tests whether students understand that de-gloving is a full-thickness soft tissue injury, not merely epidermal or dermal damage. NBE uses this as a 'too simple' distractor.

High-Yield Facts

Mnemonics

DEGLOV Depth Dermis + Epidermis + Grease (fat) + Loss from Overlying Vasculature = stops at fascia. Fascia is the 'floor' that remains. Plane of Cleavage De-gloving = Skin + Fat OFF Fascia (SFF rule). Fascia stays; everything superficial to it goes. Use when differentiating de-gloving from deeper avulsions.

NBE Trap

NBE conflates severity with anatomical depth: students who think "worse injury = more layers lost" may jump to options B or C. The key is recognizing that de-gloving is defined by the fascial plane boundary, not by how much tissue is missing.

Clinical Pearl

In Indian trauma centers, de-gloving injuries from RTA or machinery are orthopedic emergencies requiring urgent vascular assessment and early fasciotomy to prevent compartment syndrome. The intact fascia acts as a natural barrier but can trap hematoma—prompt drainage and coverage are critical to prevent infection and tissue necrosis.

_Reference: Bailey & Love Ch. 6 (Trauma & Wound Management); Robbins Ch. 1 (Cellular Injury & Adaptation)_