2. PENDAHULUAN
Degloving injury merupakan terlepasnya kulit dan jaringan subkutan dari fasia dan otot yang
terletak di bawahnya
• The musculocutaneous perforators are ruptured but the skin cover is often viable
Dinamakan degloving karena dianalogikan dengan proses melepas glove (sarung tangan)
Terminologi degloving terutama digunakan untuk cedera pada bagian tubuh yang berbentuk
tabung ekstremitas
Penyebab tersering kecelakaan industri dan lalu lintas
3. MEKANISME TRAUMA
Kulit dan jaringan subkutis terlepas secara paksa
dari dasar oleh kekuatan yang keras dan
mendadak
Gaya tangensial yang mengenai permukaan kulit
dengan permukaan yang ireguler dilawan
dengan gerakan yang berlawanan kulit
tertarik dan terlepas dari perforator – Shearing
force
5. PATOFISIOLOGI
Avulsi (terputusnya suplai
darah)
Kerusakan intima
Insufisiensi arteri
Kongesti vena
Devaskularisasi lemak flap
Melepas metabolik toksik
NEKROSIS
The golden period for managing avulsion injury is 8 hours after injury
6. CLOSED DEGLOVING
Jaringan subkutis terlepas dari jaringan dibawahnya,
namun permukaan kulit tampak normal
Tidak dikoreksi nekrosis
Terjadi jika ada kekuatan shear dengan energi yang
besar dalam waktu singkat
Tanda : mobilitas kulit dan fluktuasi di subkutis,
disertai jejas dan luka abrasi
Morel-Lavallée Lesions
7. A NOVEL SURGICAL TECHNIQUE FOR TREATMENT OF MOREL-LAVALLÉE LESION: ENDOSCOPIC
DEBRIDEMENT COMBINED WITH PERCUTANEOUS CUTANEO-FASCIAL SUTURE
• Endoscopic debridement was then performed in order to clean up
all the serosanguinous fluid, blood, necrotic fat or thick capsule
• Surgical sutures were passed through the skin and deep fascia.
From the top to the bottom, the space of each needle was about
1.5 cm, covering the entire MLL
• Then the fluid in the cavity was sucked away
• Elastic skin tubes were inserted into the sutures (preventing skin
necrosis caused by skin pressure during knotting.)
8. OPEN DEGLOVING
Merupakan cedera degloving dengan jaringan kulit terpisah
dari dasarnya disertai terputusnya permukaan kulit
80% disertai Fraktur
Tanda: terangkatnya kulit dari jaringan sekitar disertai
dengan luka terbuka
Risiko tinggi untuk terjadi infeksi dan sepsis
9. CLASSIFICATION
BASED ON FORCE
ETIOLOGY
Purely Degloving Injury
Pattern 1: Purely Degloving Injury
Pattern 2: Degloving Injury with
deep soft tissues involvement
Pattern 3: Degloving Injury with
long bone fracture
Yan H, Gao W, Li Z, Wang C, Liu S, Zhang F, et al. The management of degloving
injury of lower extremities: Technical refinement and classification. J Trauma
10. PEMERIKSAAN FISIK
Kulit dan jaringan lunak dibawahnya terlepas
dari dasarnya (fascia)
Disertai atau tidak disertai terputusnya
kontinuitas permukaan kulit
Fluktuasi di subkutis
Jejas ban kendaraan atau luka bakar akibat
gesekan
Abrasi, ecchymosis
•Tes
vitalitas:
Warna, suhu
Ada/tidaknya perdarahan --> CRT<2”/
scratch/prick test
Tes fluoresen IV (15 mg/kg dlm 200 cc
NaCl 0.9% selama 10 menit lalu lihat di
bawah lampu UV pd ruangan gelap)
mungkin overestimasi batas demarkasi
1.Extent of the skin loss
2.Exposure / injury of vital structures
12. TATALAKSANA
Sesuai ATLS
Prinsip
• Preservasi jaringan
• Tutup kulit definitif sedini mungkin
• Tutup dengan kulit kualitas baik
• Rehabilitasi fungsi
• Prosedur sekunder: revisi scar, thinning flap
Priority : life-threatening injuries
13. Bila masih terdapat
deformitas
kontur/perdarahan
banyak, luka dibuka
lebar, explorasi
Debridement dan irigasi
Penilaian otot warna,
konsistensi, perdarahan,
kontraktilitas
• Jika tidak vital dieksisi
Otot yang viabel dirotasi
atau transposisi untuk
menutup tulang yang
ekspose
STSG segera atau ditunda
14. Velazquez C, Whitaker L, Pestana IA.
Degloving Soft Tissue Injuries of the
Extremity: Characterization, Categorization,
Outcomes, and Management. Plast
Reconstr Surg Glob Open.
2020;8(11):e3277. Published 2020 Nov 23.
doi:10.1097/GOX.0000000000003277
15. PENILAIAN VITALITAS
KULIT
Jahitkan flap degloving kembali ke posisi
anatomi semula
Penilaian vaskularisasi flap degloving
• Tes tekan (CRT)
• Tes fluoresens
Split thickness skin excision (STSE) lihat titik –
titik perdarahan
Eksisi pada batas tepi luka yang sehat
Skin graft Humby knife (Watson
knife)
18. REFERENCES
1. Hakim S, Ahmed K, El-menyar A, Jabbour G, Peralta R, Nabir S, et al. Patterns and management of degloving injuries : a single national level 1 trauma center experience.World J
Emerg Surg.World Journal of Emergency Surgery; 2016;11(35):1–8.
2. Mello DF,Assef JC, Soldá SC, Helene Jr A. Degloving injuries of trunk and limbs: comparison of outcomes of early versus delayed assessment by the plastic surgery team. Rev Col
Bras Cir. SciELO Brasil; 2015;42(3):143–8.
3. Lekuya HM,Alenyo R, Kajja I, Bangirana A, Mbiine R, DengAN, et al. Degloving injuries with versus without underlying fracture in a sub-Saharan African tertiary hospital : a
prospective observational study. J Orthop Surg Res. Journal of Orthopaedic Surgery and Research; 2018;13(2):1–12.
4. Latifi R, El-hennawy H, El-menyar A, Peralta R,Asim M, Consunji R, et al.The therapeutic challenges of degloving soft-tissue injuries. J EmergTrauma Shock. 2014;7(3):228–32.
5. Wojcicki P,WojtkiewiczW, Drozdowski P. Severe lower extremities degloving injuries-medical problems and treatment results. Pol Przegl Chir. 2011;83(5):276–82.
6. Brunicardi FC, Andersen DK, BilliarTR, Dunn DL, Hunter JG, Matthews JB, et al. Schwartz’s Principles of Surgery, 11th edition. 11th ed. NewYork: McGraw Hill; 2019.
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14. Prayuda MR, Wulan AJ. Peran SplitThickness Skin Graft (STSG) pada Open Degloving. J Agromedicine Unila. FK Unila/JUKE Unila; 2018;5(2):632–7.
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2016;55(4):852–6.
The general principles of treatment of degloving injury are to retain as much tissue as possible, the initial and good quality skin coverings and return of initial function.
