Are Steri-Strips (adhesive strips) necessary for managing degloving injuries?

Management of Degloving Injuries: Steri-Strips Not Required

Steri-strips are not necessary for managing degloving injuries and do not reduce the incidence of surgical site infections. 1

Understanding Degloving Injuries

Degloving injuries occur when skin and subcutaneous tissue are forcibly separated from underlying fascia, muscle, or bone. These injuries range from occult damage to massive tissue destruction and require specialized management approaches:

• Severity ranges from partial to complete circumferential degloving
• Commonly affect extremities but can involve torso and face
• Associated with high morbidity and mortality if mismanaged 2

Primary Management Approach

The management of degloving injuries follows these key principles:

1. Initial Assessment and Stabilization

   • For severe limb trauma with active hemorrhage, apply a tourniquet if direct compression is ineffective, especially with amputation or lack of radial pulse 1
   • Reassess tourniquet necessity frequently to minimize ischemic complications

2. Definitive Wound Management

   • Degloved tissue should be excised, defatted, fenestrated, and reapplied as a full-thickness skin graft 3
   • Immediate use of degloved skin as full or split-thickness graft provides the most satisfactory coverage 4
   • Primary reattachment of full-thickness flap by suture alone without grafting is unsuccessful and should be avoided 4

3. Advanced Techniques

   • Vacuum-assisted closure (VAC) devices provide rapid, effective, and easy-to-use alternatives to traditional dressings 3
   • VAC therapy distributes even pressure and avoids shear stress to newly grafted skin

Why Steri-Strips Are Not Necessary

According to the World Journal of Emergency Surgery guidelines, "The use of steri-strips doesn't reduce the incidence of SSI" 1. For degloving injuries specifically:

• Steri-strips cannot provide the necessary support for the extensive tissue damage in degloving injuries
• They are inadequate for securing full-thickness skin grafts that require even pressure distribution
• More robust fixation methods are needed for the successful take of grafted tissue

Classification and Prognosis

Degloving injuries can be classified into three patterns that guide management and predict outcomes 5:

1. Pattern 1: Pure degloving injury (higher primary healing rates)
2. Pattern 2: Degloving with deep soft tissue involvement (higher primary healing rates)
3. Pattern 3: Degloving with long-bone fractures (lower primary healing rates, especially in older patients)

Important Considerations and Pitfalls

• Daily monitoring is critical: Observe the graft/flap until it becomes fixed to detect early complications 4
• Immobilization: The affected extremity must be immobilized postoperatively to prevent shearing forces 4
• Avoid delayed treatment: Early recognition and management are essential to prevent tissue necrosis and infection 2
• Beware of underestimation: The serious nature of degloving injuries is often exacerbated by mismanagement or underestimation of their severity 3, 2

For optimal outcomes in degloving injuries, focus on proper surgical debridement, appropriate grafting techniques, and effective pressure dressings rather than relying on steri-strips, which have not been shown to provide benefit in these complex injuries.