Degloved Face

What is a Degloved Face or Face Avulsion: Causes, Types & Treatments

A degloved face or face avulsion is a term to describe a severe facial injury that involves skin separation from the underlying muscle tissues or bones. In other terms, it is a severe medical condition in which some part of the facial skin of the patient rips off and muscle tissue or bones show up. It is a life-threatening medical condition and horrifying for people who experience it and for those too who witness it.

It is not so common but not an uncommon medical condition as well. Most cases of a degloved face happen during accidents or due to atrocity and there is no denying that these things happen often. 

Face degloving needs immediate attention and emergency medical treatment as it causes massive loss of blood and muscle tissue count. If a patient with the face degloved doesn’t get at least the first-aid treatment right away, the condition may get worse and even chances for survival may also get blurred. 

Continue reading to learn about this severe facial injury in detail. 

What is a Degloved Face? 

A degloved face can horrify any person who experiences it, witness it, or imagine it. It is a deadly facial injury where the partial skin along with muscle tissues comes off. In some cases, the skin detaches from the body while on other occasions, it comes off and hangs like a flap which is hard to see for anyone. 

This is not an illness but a serious facial injury or medical condition that happens due to road accidents, air accidents, industrial accidents, construction accidents, collisions in sports, and intentional violence. 

Possible Causes of a Degloved Face 

A degloving injury, whether facial or in other body parts, is usually the result of an accident or intentional violence. 

Here are some possible causes for facial degloving:

  • Exposure to harmful chemicals 
  • Industrial accidents 
  • Fall from a height
  • Fall on a rough surface
  • Slip or fall on the glass pieces 
  • Road accidents
  • Air accidents
  • Blasts 
  • Accidents during a construction process
  • Animal attack
  • Fighting with weapons 
  • Intentional attack with a knife or gun 
  • Collisions or accidents while playing outdoor sports
  • Burns

Among all these causes, road accidents are the most common cause of this severe facial injury. 

According to NHTSA, 42,915 people died due to road accidents in the USA in 2012. Before that year, the figure for fatalities due to road accidents in the US was 38,824. Most of these fatalities happen only due to the loss of lots of blood and muscle tissues. And this happens usually in degloving injuries. So, most people who lose their lives due to road accidents, actually lose their lives due to a degloved face, leg, hand, back, chest, or buttock. 

Types of a Face Degloving Injuries

There are mainly two types of degloved faces; open face and closed face. 

Open Face Degloved

Open-face degloving is more common than closed degloving faces. It is basically those severe facial injuries that involve noticeable facial skin separation from the muscles and bones. In an open degloving face, a person can easily find out that the skin is ripped off and muscle tissue or bones are exposed. These types of facial injuries indicate that the accident was extremely dangerous. 

In an open facial degloving injury, it is a bit easier for doctors to diagnose the injury type and make a better surgery plan. They can examine the degloved face without the need for an incision. 

These injuries happen due to dangerous road accidents, air accidents, industrial accidents, and more.

Closed Face Degloving

As the term implies, a closed degloved face is a condition where the skin gets separated from the connective muscle tissue and bones from the inside but it is not noticeable from the outside. Some bruises and cuts may come to notice but it is usually tough to claim whether it is a degloved injury or not. 

These types of facial degloving are more complicated. Physicians find it tough to diagnose and treat. Some scans are performed by doctors to identify the type of this severe facial injury. 

Closed facial degloving also happens due to the types of accidents that cause an open-degloved face. The position of the body, impact on the face, and hardness, roughness, and sharpness of the object that is involved in the collision are what make the difference. 

Consequences and Complications of Facial Degloving 

The consequences of a facial degloving injury can be horrible. First things first, it is extremely painful. It gives unbearable pain. Secondly, it results in a massive loss of blood from the body which can lead to loss of life. Loss of muscle tissues in a great amount is also associated with this injury and this can have a long-term impact on patient’s lives. 

Additional injuries like broken bones, dislocation, and cracked bones are also linked with a degloved face. The chances of infection are also very high as the muscle tissues usually remain in contact with air for quite a long time. Body aches and fever are also normal with it. Once it happens, it has long-lasting effects. 

A patient may experience some complications even after undergoing a successful facial degloving surgery or recovering from it. Complications include:

  • Loss of the original shape of the face
  • Unshaped nose, ears, or lips
  • Awkward smile
  • Clearly visible surgery spots on the face 
  • Loss of eyesight
  • Loss of vocal cords
  • Loss of smell sense
  • Loss of hearing ability
  • Teeth loss

Treatment Options for a Facial Degloving Injury 

Different types of treatment options can be utilized by surgeons for a degloved face. It heavily depends on the extent of the degloved facial part and the amount of loss of muscle tissue and blood count.

Mild to a moderate facial degloving injury can be treated with some first aid treatments like cleaning the degloved facial part and then bandaging it. However, for severe degloving face injuries, physicians consider reconstructive surgeries, skin grafts, or amputation.

Reconstructive Degloved Face Surgery

Reconstructive surgery is required when the skin is partially or completely separated from muscle tissues or bones and one or more parts of the face are either damaged or displaced. Reconstructive or restorative degloved face surgery re-attaches the displaced facial parts and repairs the skin to regain the face shape and appearance of the patient. 

This type of reconstructive surgery includes removing the damaged skin, cleaning the degloved area, re-attaching or fixing the displaced parts, stitching the skin, and bandaging it. Surgery for facial degloving is performed by experienced surgeons in trauma centers. Not all hospitals have the resources and expertise to provide face surgery. Patients with a degloved face should be admitted to a trauma center for treatment. 

Skin Grafts

Skin grafting is required when a patient loses a great number of muscle tissues from a degloved face. It is a surgical process of taking a healthy flash from a part of the body like the thigh and then transplanting it to the degloved area in the face. This process is performed to recover the loss of muscle tissue. This type of surgical procedure is performed in large hospitals and trauma centers. 

Amputation 

Amputation is a process of partially or completely removing some part of the body like the nose, ears, legs, fingers, etc. In a degloved face, if some facial features (like the nose and ears) get badly damaged, surgeons may consider this surgical procedure.

Reattachment of Facial Features 

Reattachment involves reattaching the damaged facial features. If the nose, lips, ears, or other facial features get displaced during the accident, surgeons may consider a reattachment procedure. 

This is a very complicated surgical procedure and a real challenge for any surgeon. This involves a risk of patients losing their original face shape and identity. 

Blood Transfusions

Blood Transfusion is a process to provide the patient with donated blood intravenously. Doctors consider this process when the patient with a degloved face lost a huge amount of blood during the accident or due to the ripped facial skin. This process is crucial to recover the blood count in the patient’s body.

Medications 

Antibiotics, painkillers, and anesthesia are provided by physicians to patients to reduce pain, swelling, and infections. Some other medications physicians provide the patients for faster recovery.

Tips to Care Degloved Face 

A patient with a facial degloving injury needs proper care. Without it, the recovery process may get delayed or the condition gets worse. Here are some crucial care tips that patients with a degloving injury must follow. Find out the tips below:

Regular Wound Cleaning and Dressing 

Regular wound cleaning and dressing are vital to support the healing process. This provides an optimum environment and support for wounds to recover. A home care professional may assist the patient with wound care. Do wound cleaning and dressing regularly as suggested by the doctor. 

Protect the Degloved Face Wound From Infection 

If a degloved face part comes into contact with external elements, an infection may occur. You need to prevent it by following the best wound care and home health care practices. 

Avoid Speaking Much 

Especially in the first few weeks of recovery, avoid speaking much. Speaking is an activity that involves the entire lower half of the mouth and the muscles of the sides of the face as well. When you speak, it impacts all these parts of your mouth. And if you have a degloving injury in the sides of the face of the lower half of the mouth, you will feel intense pain while speaking. This may also disturb or delay the recovery process as the muscles and bones of the face do movements as when you speak. 

Do Not Eat Hard-to-Chew Foods 

Your jaw has to put extra pressure to chew hard foods like meat or chapati. And this pressure comes from a combined force of different facial muscles and bones. If you chew hard foods, your facial muscle has to work hard and that’s why it may affect the healing or recovery process of the degloved face. Thus avoid eating hard-to-chew foods while you are in the recovery stage. You can take soft-to-bite or chew foods like bread.

Avoid Touching or Itching the Surgical Area Frequently 

The bandages on the face are usually heavy and seem like a separate part is attached to the face. This compels the patient to touch the surgical area again and again. Try to avoid this habit. Another thing is that patients often start itching the surgical area as they feel irritation at those parts due to bandages. Avoid this or also you might end up worsening your condition. 

Degloved Face Recovery 

Facial degloving is a severe medical condition and thus it takes patients 2 to 8 months to fully recover, depending on the severity of the injury. For faster recovery, proper care, medications, and having a strong desire to get recovered is extremely important. Your surgeons or doctors may give you the right estimate for the recovery time for the successfully repaired face that was degloved. 

Conclusion

A degloved face is a severe facial injury where some part of the skin comes off the muscle tissue and bones. It happens usually due to accidents and it needs immediate treatment. Trauma centers are the correct place to admit patients with a facial degloving injury as treatments for this type of severe degloving injury are not available at every hospital. 

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