Degloving

Under a décollement (French, shearing ', Deco ller, " peel off "), even degloving, refers to the separation of the skin from the subcutaneous adipose tissue ( subcutaneous tissue ) and / or the muscle fascia by external forces.

Formation

The décollement is produced by squeezing a strong influence of simultaneous displacement of the skin on its base by tangential ( shearing ) forces. This subcutaneous fat is as far overstretched that it breaks off from the inside of the skin and thus the blood circulation and the nerve supply to the skin is lost from its base in the affected district. Here Tear down the skin like the décollement the scalp, so the diet of the skin flap is performed only on a stalk. In case of gross disproportion between stem to rag latter dies from untreated.

The décollement often accompanies injury in fractures of the extremities, but also occurs as a separate violation, and is then often underestimated in its severity. A typical course of the accident is the rock fall from the hanging wall in miners and the impact or rolls of a pedestrian by a motor vehicle.

Risks

If left untreated, a décollement mostly to extensive necrosis of the skin because the skin and subcutaneous hematoma between impedes the early ingrowth of capillaries in the skin. There is also - especially at the same time present an open skin lesions - the risk of a bacterial infection. The often simultaneously present pinch of the underlying musculature involves the risk of compartment syndrome. In extreme cases, threatened with the loss of the limb.

Treatment

The treatment is operative to perform normally: Already irrevocably damaged skin components are removed, the hematoma under the intact skin is cleared and drained, destroyed subcutaneous tissue is also removed, the detached skin is fixed with internal " stitching " on the subcutis. As a result, skin grafts are often required. Associated injuries, v. a fracture must also be carefully supplied.

Healing and late effects

The décollement heals only from consequences, if it is of small extent and was effectively treated early. Otherwise often remain extensive scarring plates, which resulted in scar with extensive dysfunction, such as restrictions on movement, may occur.

Swell

• H.-P. Sharp, A. Ruter, T. Pohlemann: Orthopaedics and trauma surgery. Urban & Fischer Verlag, Elsevier, Munich 2008, ISBN 3-437-24400-0, p.125