What is the treatment for skin avulsion?

From the Guidelines

Skin avulsion treatment requires immediate medical attention and a multi-step approach, prioritizing controlling bleeding, cleaning the wound, and seeking emergency medical care to minimize morbidity, mortality, and optimize quality of life. The initial steps involve controlling any bleeding with direct pressure and elevating the affected area. Clean the wound gently with sterile saline solution or mild soap and water, as recommended for wounds and abrasions 1. Do not attempt to remove any foreign objects embedded in the wound. Cover the avulsed area with a moist, sterile dressing and seek emergency medical care.

At the hospital, treatment will depend on the severity of the avulsion. For partial avulsions, the skin may be reattached if viable. Complete avulsions may require skin grafting or reconstructive surgery. The wound will be thoroughly cleaned and debrided of any dead tissue. Tetanus prophylaxis is typically administered if the patient's immunization is not up to date. Some studies suggest the use of antibiotic therapy to prevent infection, however the most recent and highest quality study does not provide specific recommendations for skin avulsion treatment 1. Pain management is crucial and may involve oral analgesics like ibuprofen (400-600 mg every 6 hours) or stronger opioids if necessary. Follow-up care is essential, including keeping the wound clean and changing dressings as directed, typically daily or every other day, and watching for signs of infection such as increased pain, redness, swelling, or fever. Avoid submerging the wound in water until it has healed sufficiently. Physical therapy may be recommended to maintain flexibility and strength in the affected area.

The goal of this treatment approach is to promote optimal healing while minimizing the risk of complications such as infection or loss of function. Proper wound care and follow-up are crucial because skin avulsions can compromise the skin's protective barrier and potentially lead to serious infections if not managed correctly.

From the Research

Treatment Options for Skin Avulsion

• Vacuum sealing drainage (VSD) can be used to treat late-stage large skin avulsion injury with infection, as it helps to alleviate tissue edema and promote wound closure 2.
• The combination of Vacuum Assisted Closure (VAC) system and Integra Dermal Regeneration Template (IDRT) can be used to treat massive lower extremity avulsion injuries in children, promoting wound cleansing, wound bed conditioning, and reconstruction of near normal skin 3.
• Basic fibroblast growth factor (bFGF) can be applied to the graft bed to promote epithelialization and wound healing in skin avulsion injuries of the extremities 4.
• Primary reattachment of avulsed skin flaps with negative pressure wound therapy can be used to treat degloving injuries of the lower extremity, promoting graft take and reducing the need for additional surgical procedures 5.
• Island flaps or skin graft combined with vacuum assisted closure can be used to treat large avulsion injuries in the perianal, sacral, and perineal regions, promoting wound healing and protecting the function of the anus 6.

Surgical Procedures

• Free split-thickness skin grafting can be performed after debridement and VSD treatments to promote wound closure 2.
• Autologous split thickness skin grafting (STSG) can be used to achieve definitive wound closure after VAC and IDRT application 3.
• Full-thickness skin grafting and bFGF application can be used to treat skin avulsion injuries of the extremities, promoting wound healing and preventing postoperative ulcer formation and scar contracture 4.
• Defatted avulsed skin flaps can be reattached to the original position and secured with negative-pressure wound therapy to promote graft take 5.
• Island flaps or skin graft combined with vacuum assisted closure can be used to treat large avulsion injuries in the perianal, sacral, and perineal regions, promoting wound healing and protecting the function of the anus 6.

Wound Care and Management

• VSD treatments can be used to alleviate tissue edema and promote wound closure in late-stage large skin avulsion injury with infection 2.
• VAC application can be used to promote wound cleansing and wound bed conditioning in massive lower extremity avulsion injuries in children 3.
• bFGF can be sprayed onto the graft bed to promote epithelialization and wound healing in skin avulsion injuries of the extremities 4.
• Negative-pressure wound therapy can be used to promote graft take and reduce the need for additional surgical procedures in degloving injuries of the lower extremity 5.
• Vacuum assisted closure can be used to promote wound healing and protect the function of the anus in large avulsion injuries in the perianal, sacral, and perineal regions 6.