What are major traumas?

Major trauma to the hand and upper limb can be devastating injuries that change the course of life for the injured person. These injuries usually involve a high energy mechanism like industrial machines, heavy weights or high-speed car and motorbike accidents.

Degloving, also known as avulsion, is a type of severe injury which occurs when the top layers of your skin and tissue are ripped apart from the underlying connective tissue, muscle or the bone.

These injuries are commonly associated with other injuries of the chest, spine or lower limbs. It is therefore essential that these injuries are evaluated and treated in a tertiary dedicated specialist unit. Major trauma injuries usually involve fractures of the skeletal bone structure associated with soft tissue injury, invariably involving the skin, muscle-tendon units, arteries and nerves. It is imperative that a hand specialist manages these injuries.

How are traumas and degloving upper limbs treated?

Treatment for major traumas and degloving upper limb injuries depends on the type, severity and location of the injury. Priority is always given to save the limb, which requires resuscitation of the patient to ensure good vascular perfusion of the limb. Sometimes urgent revascularisation is required. The hand surgeon will fix the bone framework to create stability to allow initiation of the early movement. Tendons and nerves are meticulously repaired to ensure the best outcome.

Depending on the amount of skin left after the injury and the type of injury, treatment may include reattaching your skin, reattachment of the finger, or using skin grafts from a donor. A hand surgeon may also amputate the affected limb. Early treatment of these injuries helps in preventing any infections that may occur. These injuries always require prolonged rehabilitation. Dr van der Spuy may recommend physical therapy after hand surgery, to help improve your hand’s functionality.

Thumb degloving injury

Thumb degloving surgery


Thumb degloving outcome

General Trauma