A degloved face is a rare but serious injury that can occur from high-impact traumas like car accidents or industrial accidents. The term “degloved” refers to how the facial skin is completely torn off the underlying muscle and bone, like peeling off a glove. This brutal injury leaves the facial muscles, nerves, and blood vessels exposed. Treatment focuses on covering the exposed areas as quickly as possible, often using the patient’s detached skin if viable or skin grafts.
Recovery is long and difficult, requiring multiple reconstructive surgeries and physical therapy. Patients are left with significant scarring and potentially impaired functions like eating, speaking, or facial expressions. Though challenging, with proper treatment and support many can regain a good quality of life. This article will cover the causes, treatment, and road to recovery from these traumatic facial injuries.
What is a Degloved Face?
A degloved face is a severe facial injury where the skin is completely torn off the underlying facial muscles, nerves, blood vessels, and bone structure. It is an extremely rare injury that requires complex reconstructive surgery.
In a degloving injury, the facial skin detaches from the rest of the face in a similar way that a glove can be peeled off the hand. This occurs when the face suffers extreme trauma, often from high-speed motor vehicles or industrial accidents. The traumatic force literally rips the facial skin and soft tissue completely off the facial skeleton in one piece.
This leaves the facial muscles, nerves, vessels, and bones totally exposed. Facial muscles like the ones controlling expression or chewing can be partially or fully severed. Facial nerves may be damaged, causing paralysis. Blood vessels rupture, causing severe bleeding. With the skin detached, the underlying structures have no protection and are vulnerable to infection.
What are the Causes of Degloved Face Injuries?
Degloved face injuries are severe traumatic wounds where the skin is completely torn off the underlying facial tissues, disconnecting it from its blood supply and nerves. These injuries most commonly affect the nose, lips, eyelids, forehead, and cheeks. What causes such damage leading to facial skin being degloved?
Motor Vehicle Accidents
Motor vehicle accidents are a major cause of degloving facial trauma. When the face forcefully impacts interior components like the steering wheel, window glass, or side panels in a crash, the high energy can avulse or tear off the skin from the bone, cartilage, and muscles beneath. Properly worn seat belts are essential to prevent the violent body motions that often lead to degloving wounds in car accidents.
Animals Bits
Animal bites, especially from large pets like dogs, also frequently deglove areas of the face as the skin is shredded by teeth and pulling motions. Industrial and machinery accidents can catch and snag the face in equipment, traumatically ripping off the skin by the spinning, grinding, or crushing forces involved. Explosions release enormous energy in a blast that can essentially blow off the skin from the foundations of bone, muscle, and nerves underneath. Severe physical assaults involving pulling, hitting, or dragging facial skin could also cause degloving injuries by forcibly separating the skin from underlying structures.
Industrial/Machinery Accidents
The location and extent of degloving depends on factors like the direction and intensity of the applied force and which part of the face is affected. The nose, ears, lips, cheeks, eyelids, and forehead are frequent sites of degloving injuries. While still attached at the edges, degloved skin is lifted away and detached from the tissue below, exposing facial muscles, nerves, vascular structures, cartilage, and bone to open air. This increases severe infection risks.
Explosions
Symptoms of facial degloving are immediately drastic, with extreme pain, heavy bleeding, numbness, loss of sensation, swelling, bruising, and difficulty moving the face. The severed nerves cannot transmit signals, resulting in paralysis. Lack of blood circulation also compromises any surviving skin.
Falls and Sports Accidents
Falls and sports accidents are another cause – the impact of falling or collisions with equipment, balls, other players, or the ground may impart enough force to deglove part of the face.
Physical abuse
Physical assaults often involve closed-fist punches, kicks from a shoe, or being struck forcefully with an object. The location of blunt trauma impacts affects the facial structures most likely to be degloved. Blows to the cheek, nose, mouth, and orbital areas carry a high risk of detaching skin from cartilage, bone, and muscle if the magnitude and direction of force are sufficient. Repeated abuse compounds injury by increasing tissue damage and fragmentation deep into the skin layers.
The severity of degloving and the resulting deficits depend on factors like the magnitude of force, location on the face, and direction of the force. Prevention focuses on wearing seat belts to limit injury in crashes, exercising caution around machinery and animals that can deglove skin, and avoiding physical violence.
Emergency Treatment for a Degloved Face
When the face is degloved, the treatment focuses on controlling bleeding, preventing infection, stabilizing fractures, and beginning the reconstruction process. Here is the guide for emergency treatment of the degloved face.
Control Bleeding and Stabilize the Patient
The first priority in treating a degloved face is to control any bleeding and stabilize the patient. Applying pressure and tourniquets may be necessary to stop blood loss. IV fluids and oxygen are administered to maintain blood pressure and oxygen levels. Pain medication can also help stabilize the patient.
Seek Immediate Medical Attention
A degloved face is a traumatic, life-threatening injury requiring emergency medical care. Paramedics should be called immediately to transport the patient to the closest emergency room. Time is critical for successfully reattaching the degloved skin.
Administer Antibiotics
Broad-spectrum antibiotics are given immediately through an IV to prevent infection in the exposed facial tissue. Antibiotics will continue to be administered throughout treatment. Infection poses a serious risk that could jeopardize reattaching the skin flap.
Reconstruct the Face with Skin Grafts
Once bleeding is under control, surgeons work to reattach the degloved skin flap. Skin grafts or flaps may be needed if some tissue is damaged or lost. Proper realignment of the facial skin is critical for healing.
Prevent Infection with Ongoing Antibiotic Treatment
IV antibiotics continue after surgery to prevent infection while the facial tissue heals. Oral antibiotics may be prescribed after hospital discharge as well. Infection prevention is key.
Treat Broken Facial Bones
If any facial bones like the nose, cheekbones, or jaw are fractured, those need to be set and stabilized. Proper bone alignment provides support for reconstructing the soft facial tissues.
Regain Function with Physical Therapy
Once the skin is reattached, physical therapy helps regain facial muscle tone, movement, and expression. This improves functions like chewing, speaking, and smiling.
Recovery from a Degloved Face
Multiple Reconstructive Surgeries
Recovering from a facial degloving takes several surgeries over months or years. The initial surgery reattaches and grafts skin flaps. Follow-up surgeries make adjustments to improve the appearance and function as healing progresses. Some people undergo dozens of revision surgeries.
Coping with Facial Scars and Changes
Despite reconstructive surgery, scarring from a degloved face is inevitable. Learning to accept and even embrace scars can be challenging. Support groups connect people dealing with similar traumas. Make-up, clothing, and hairstyles also help individuals feel confident post-injury.
Seeking Psychotherapy
Experiencing a degloving often requires psychotherapy to process the trauma and adjust to changes in appearance and abilities. Body image issues, depression, and low self-esteem are common. Counseling provides tools to build self-acceptance and self-worth.
Finding Support Through Groups
Support groups for burn or trauma victims can provide a community for those recovering from degloving injuries. Sharing experiences, advice, and encouragement with others who understand the struggle helps many people heal emotionally. Charities also provide resources for people recovering from disfiguring facial injuries.
Moving Forward with Time
While degloving recovery is measured in years, not days or weeks, the human spirit is resilient. With time, support, advanced medical care, and determination, survivors can adapt to a new normal and build fulfilling lives post-injury. Patience, self-care, and hope to help individuals continue moving forward.
Prevention Strategies for Degloved Faces
While some degloving injuries are unpredictable accidents, there are prevention strategies that can reduce risk.
Wear Protective Face Gear
Wearing helmets, face shields, and other protective equipment can help prevent degloving from impacts, falls, and trauma. Workplaces with injury risks should require appropriate safety gear.
Avoid Moving Machine Parts
Rotating, grinding, or cutting machine parts poses degloving hazards. Ensure moving parts are properly shielded. Do not wear loose clothing or jewelry around machinery. Follow safety protocols.
Secure Long Hair
Long hair can get caught in machinery and rip off scalp skin. Wear hair back securely or covered when working around potential risks.
Drive Defensively
Car accidents are a common cause of facial degloving. Defensive driving techniques, like wearing seatbelts, obeying speed limits, and avoiding distractions, reduce accident risks.
Remove Trip Hazards
Cluttered floors, uneven surfaces, and unsecured rugs create fall risks resulting in degloving. Keep walkways clear and install grip strips on stairs. Fix loose carpeting. Improve lighting.
Supervise Children
Child facial injuries frequently occur from falls. Closely supervise young children and baby-proof homes to minimize fall risks. Ensure kids wear helmets for activities like biking, skating, or riding scooters.
Prevention and safety awareness are key to avoiding catastrophic degloving injuries, especially in workplaces or activities with high risks. Protective gear and common sense precautions can help keep people’s faces intact.
Types of Degloving Injuries
Degloving injuries are severe traumatic wounds where the skin and underlying tissues are stripped away from the deeper structures of the body. There are three main classifications of these injuries depending on the nature and extent of tissue separation:
Open Degloving Injuries
Open degloving is the most drastic type, involving complete avulsion of the skin and subcutaneous fat from the fascia, muscles, tendons, nerves, vessels, and bones beneath. This fully exposes the vulnerable inner structures and leaves them unprotected. Open deglovings usually result from high-energy trauma such as motor vehicle crashes, industrial accidents, animal attacks, or assaults. They require extensive surgical debridement, reattachment of avulsed skin segments, skin grafting, and flap procedures to cover defects.
Closed Degloving Injuries
In closed or subcutaneous degloving, the skin remains intact on the surface but the subsurface tissues are stripped away from the deeper structures. The skin takes on a normal appearance but is separated and mobile from the foundations underneath. Closed degloving results from shear stress and blunt trauma like crush injuries, falls, and collisions. MRI helps assess the extent of deep tissue separation. Surgery is still needed to repair and re-anchor the detached tissues.
Mangled Extremity Degloving Injuries
This severe injury pattern combines extensive soft tissue damage, including degloving, with severe skeletal and vascular destruction in an extremity. It is usually caused by high-energy industrial accidents, explosions, or building collapses. The limb is often unsalvageable, requiring amputation. If attempted, salvage requires multiple surgeries for fracture fixation, flaps, and grafting. Even then, complications like infection and necrosis are common.
The location and extent of degloving depend on the mechanism and magnitude of the initial traumatic forces. Swift diagnosis and urgent surgical treatment are necessary to reestablish skin viability and prevent severe complications.
Bottom Line
Degloving injuries to the face are rare and complex traumas requiring meticulous reconstruction for optimal outcomes. Proper airway management is the first priority, followed by radical debridement and realignment of avulsed soft tissues. Layered repair with local flaps enables good aesthetic and functional results. However, these severe injuries often necessitate staged procedures for the best outcomes.
Trauma from interpersonal violence disproportionately affects women, with domestic assault a leading cause of facial injuries. Degloving from sharp weapons can cause extensive avulsions, as in this case report of a patient assaulted with a sickle. Despite the initial ghastly appearance, methodical reapproximation of anatomical structures allowed the use of local forehead and nasolabial flaps for surface coverage. Further refinements were planned later.
With proper emergency response, radical debridement, anatomical realignment in layers, and local tissue transfers, optimal functional and cosmetic outcomes are possible even with extensive degloving. Staged procedures may be prudent to minimize complications like infections from contamination. Careful planning and execution are key to reconstructing these challenging traumatic facial wounds.
Frequently Asked Questions
What are the types of facial degloving injuries?
The main types are open degloving with complete skin avulsion, closed degloving where the skin is intact but subsurface tissues are separated, and mangled extremity degloving which also involves bone and vascular damage.
How are degloved face injuries treated?
Emergency surgery is needed to reattach any detached skin flaps while still viable. Skin grafts or flaps may be required to cover defects. Treatment focuses on restoring skin perfusion and preventing severe infection.
What is the prognosis after a degloved face injury?
With prompt expert surgery, outcomes can be good but nerve damage may cause permanent numbness or paralysis. Rehabilitation helps maximize function. Scarring is likely, and staged procedures may be needed for the best results.
How can degloved facial injuries be prevented?
Protective strategies like wearing seatbelts, avoiding contact with dangerous machinery/animals, and preventing physical violence/assault to the face. Seeking immediate medical care if degloving occurs gives the best chance to restore form and function.
