From the Guidelines
TBI refers to traumatic brain injury, which is damage to the brain caused by an external force, such as a blow to the head or penetrating injury, and a degloving injury occurs when the skin and soft tissues are forcibly separated from underlying structures, essentially "degloved" from the body, requiring immediate medical attention and complex treatment interventions. This can result in temporary or permanent impairment of cognitive, physical, and psychosocial functions. The management of severe TBI patients, as recommended by the World Society of Emergency Surgery (WSES) consensus conference guidelines 1, involves monitoring and management strategies during the first 24 hours after injury, including the prevention of further brain damage, control of intracranial pressure, and prompt treatment of systemic insults such as hypoxia, hypercapnia, and systemic hypotension. Some key points to consider in the management of TBI and degloving injuries include:
- Monitoring brain function and controlling intracranial pressure to prevent further brain damage 1
- Prompt treatment of systemic insults such as hypoxia, hypercapnia, and systemic hypotension to prevent secondary injury 1
- Complex surgical interventions, including debridement of nonviable tissue, skin grafts, or flap procedures to cover exposed areas in degloving injuries 1
- The importance of transferring patients to a specialized center with neurosurgical facilities as soon as possible to improve outcomes 1
- The use of targeted temperature control (TTC) to prevent further brain injury and improve neurological outcome, although the role of TTC in improving long-term outcome and its appropriate indications, targets, and duration are currently unknown 1. Recovery from both conditions can be lengthy and may involve multiple specialists, including neurosurgeons, plastic surgeons, physical therapists, and rehabilitation specialists.
From the Research
Definition of TBI and Degloving Injury
- TBI stands for Traumatic Brain Injury, which is a type of injury that occurs when the brain is damaged due to a blow or jolt to the head [ 2, [ 3, [ 4, [ 5 ].
- Degloving injury is a type of injury where the skin and soft tissue are stripped away from the underlying muscle and bone, often due to trauma [ 6 ].
Treatment of TBI
- Hyperosmolar agents such as mannitol and hypertonic saline are commonly used to treat elevated intracranial pressure in TBI patients [ 2, [ 3, [ 4, [ 5 ].
- The choice of hyperosmolar agent may depend on the individual patient's condition and the preference of the treating center [ 2, [ 3 ].
Treatment of Degloving Injury
- Treatment of degloving injuries often requires a multidisciplinary approach and may involve surgery, debridement, and skin grafting [ 6 ].
- Aggressive weekly debridement with stem cell injections and membrane wraps may be used to stimulate healing in patients with degloving injuries [ 6 ].
Comparison of Mannitol and Hypertonic Saline
- Studies have compared the effects of mannitol and hypertonic saline in reducing intracranial pressure in TBI patients, with some showing similar effects [ 2, [ 4, [ 5 ].
- Other studies have found that hypertonic saline may have a more sustained effect on intracranial pressure and can effectively increase cerebral perfusion pressure [ 5 ].