From the Guidelines
The term for skin removal from a toe is "desocking" or "toe avulsion." This injury occurs when the skin is completely or partially torn off the toe, similar to how degloving affects larger body parts like hands or feet. Desocking typically results from severe trauma, such as when a toe gets caught in machinery or during accidents where significant pulling forces are applied. Treatment depends on severity but often includes:
- Wound cleaning
- Debridement of damaged tissue
- Antibiotics (such as cefazolin 1-2g IV initially, followed by oral cephalexin 500mg four times daily for 7-10 days) 1
- Pain management
- Possibly surgical intervention to reattach viable skin or perform skin grafting. These injuries require immediate medical attention as they carry high risks of infection, tissue death, and long-term functional impairment. The underlying mechanism involves shearing forces that separate the skin from deeper structures, disrupting blood supply to the affected tissues and potentially damaging nerves and tendons within the toe. It is essential to prioritize wound care and management to prevent further complications, as highlighted in the guidelines for foot care in diabetes-related foot ulcers 1. In cases of diabetes-related foot infections, surgical interventions may be necessary to promote healing and prevent further complications 1. Overall, desocking or toe avulsion requires prompt and proper medical attention to minimize morbidity, mortality, and improve quality of life.
From the Research
Definition of Degloving Injury
- A degloving injury is referred to as the separation of cutaneous tissue from the deeper structures of the body 2.
- It is a severe traumatic injury sometimes caused by rolling wheels or machines, resulting in skin and subcutis avulsion 3.
Treatment of Degloving Injuries
- Degloving injuries can be treated by defatting the degloved skin and replacing it with a full-thickness graft 4, 5.
- Negative pressure wound therapy (NPWT) can be used to secure the grafts, and gauze-based wound fillers can be used for fixation of avulsed flap skin grafts 3.
- Dermal substitutes such as Integra can also be used in reconstructive surgery for degloving injuries, especially in growing children to cover large skin losses 6.
Specific Case of Toe Injury
- Although the term "degloving" typically refers to injuries of the extremities, the concept can be applied to any area of the body where skin is removed, including the toes.
- The management of a traumatically avulsed skin-flap on the dorsum of the foot, including the toes, can be treated by defatting the avulsed flap and reattachment as a full-thickness graft 5.