How To Treat an Avulsion

What to Do if You Lose a Chunk of Your Body

infected dog bite
Potentially infected dog bite held together with staples. samsyseeds / Getty Images

Avulsions are basically chunks of tissue removed from the body, including at least all three layers of skin. They are much more than simple lacerations, but less than full amputations.

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

Degloving or Avulsion

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. We call it degloving no matter where the injury is; fingers, feet, hands, etc. It is common for rings to catch on things and cause degloving injuries of the finger. Some degloving injuries eventually result in amputations.

It can be hard to tell the difference between an avulsion and a really bad laceration. One telltale is if the laceration is through all the layers and is curved enough that you can lift up a flap of tissue. The ability to lift off some of the fat and skin is what makes it an avulsion. Generally, the treatment for a deep laceration is the same as the treat for an avulsion, if you have the section of tissue that was avulsed.

If the section of avulsed tissue is not available, treat it like a burn.

Avulsions and degloving injuries will almost always need surgical intervention to heal properly. Avulsions have long healing times that can't really be treated appropriately without a professional. 

Steps to Treat an Avulsion

  1. Stay Safe. If you are not the victim, practice universal precautions and wear personal protective equipment if available.
  1. Control bleeding with direct pressure and elevation, avoiding tourniquets unless bleeding cannot be controlled and and medical care will not be available for several hours.
    • Do not be afraid to put direct pressure on raw muscle or fat tissue. Use an absorbant clean dressing or whatever clean cloth is available.
  2. Rinse the wound with water or saline solution, the cleaner the better. Sterile irrigation is the best.
  3. If the tissue (skin, fat, and muscle) is not completely torn away, replace the flap and dress the wound. If the tissue is completely separated from the patient's body, collect it if available and bring it with the patient to the emergency department.
  4. Avulsion injuries will almost always need medical care, especially if the injury was from an animal bite. Avulsions will likely need surgical intervention and bites have a high incidence of infection.
  5. If bleeding cannot be controlled, or if the area of the avulsion cannot be covered by both of the patient's palms, then call 911. Large avulsions are significant emergencies that should be taken to the emergency department immediately.

Tools to Do It Better

  • Exam gloves
  • Trauma dressings

Sources:

Sakai, G, et al. Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity. Injury. 2017 Jan;48(1):137-141.

Sorg, H, et al. Skin Wound Healing: An Update on the Current Knowledge and Concepts. Eur Surg Res. 2017;58(1-2):81-94.

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