[Surgicalcric]

Clarification needed on something. Was only the skin removed or was skin as well as muscle removed? You stated skin down to the bone which would lead me to believe all but ligaments were removed from thumb and finger, unless I am just reading it wrong.

Now for Tx:

Moist dressings and splint as necessary,

IV with MS for pain,

and transport to bright lights and cold steel.

If you can retrieve the removed skin/other tissue do so. Place in ziploc bag on ice and transport with PT to the ED.

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Degloving is caused by shearing forces that separate tissue planes, rupturing their vascular interconnections and causing tissue death. This most frequently occurs between the subcutaneous fat and deep fascia. They can present themselves as open or closed and can also be either localized or circumferential.

The danger of degloving or avulsion injuries is that there is devascularisation of tissue and skin necrosis may become slowly apparent in the following few days. Even tissue that initially demonstrates venous bleeding may subsequently undergo necrosis if the circulation is insufficient. Treatment of such injuries is to identify the area of unperfused skin and to remove the skin, defat it and reapply it as a skin graft in part or in whole.