How to Treat an Avulsion Wound

Avulsions are severe traumatic injuries where one or more pieces of tissue are torn or detached from the body, including at least all three layers of skin. These injuries are more serious than lacerations (cuts), but they are less serious than traumatic amputations, when a finger or limb is completely cut from the body.

Avulsions are devastating injuries and come with a high risk of infections (on par with burns). These injuries are commonly caused by animal bites, industrial equipment injuries, or motor vehicle accidents (especially motorcycles).

This article will cover the causes of avulsions and how they’re treated. You’ll also learn how to take care of your wound during your recovery from an avulsion injury.

What Is an Avulsion Wound?

An avulsion injury goes through all the layers of skin. You might be able to lift up a flap of tissue that is still connected, or the tissue could be detached from the body. If the section of avulsed tissue is available and healthy enough, it can sometimes be repaired.

If the avulsed tissue is not available or too damaged, the injury is often treated like a burn where layers of skin have been severely damaged or lost.

Degloving

An avulsion that wraps all the way around an extremity and causes the layers of tissue to pull away is called a degloving injury. The name comes from the image of peeling a glove off your hand so that it ends up inside-out.

Degloving can affect any part of the body, including the fingers, feet, or hands. A common cause of degloving is when a ring catches on something and the skin or surrounding tissue of the finger is pulled off. Some degloving injuries lead to surgical amputations. 

List of Common Avulsion Injuries and Sites

An avulsion injury can happen in different areas of the body. Avulsion fractures are the most common avulsion injuries. It happens when an injury causes soft tissue (ligament or tendon) to break off a piece of bone it's attached to.

Examples of common avulsion injuries include:

• Avulsion fracture, such as tibial avulsion fracture
• Avulsion fracture of a metatarsal (toe bone)
• Ring avulsion injury from a wedding band
• Tendon avulsion, such as triceps tendon avulsion
• Muscle avulsion, such as proximal adductor avulsion
• Eye injury, such as choroidal (a layer in the back of the eye) avulsion

An avulsion injury will usually cause severe pain and bleeding. Depending on how severe the injury is, nerves can also be damaged, which may keep a person from feeling pain.

How Is an Avulsion Wound Treated?

If you or someone else has an avulsion injury, you need to get immediate medical attention by going to the nearest emergency room.

Avulsion injuries may need:

• Stitches to close the wound to help it heal.
• Reattaching skin if the flap of skin is able to be saved and will heal.
• Skin grafts, which can be done with surgery to replace full areas of skin that were not able to be saved. 

An avulsion fracture, or bone avulsion injury, usually requires rest, ice, and potentially physical therapy. It does not usually require surgery.

Recovering from an avulsion injury can take months. You might need antibiotic treatment and/or vaccinations to prevent an infection from the wound (for example, if you were attacked by an animal). 

If you get an avulsion injury, you may have other injuries like lacerations that also need to be treated and given time to heal. 

First Aid for an Avulsion

A person with an avulsion injury needs immediate medical attention, but while you are waiting for help to arrive there are some things you can do.

Here are the steps for performing first aid for an avulsion injury: 

1. Stay safe. If you are not the person who was injured, practice universal precautions and wear personal protective equipment if available. Stay clear of whatever caused the injury and only attempt to help if it is safe for you to do so. Remember: You will not be helpful if you are injured while trying to save someone else.
2. Control bleeding with direct pressure and elevation. Use an absorbent clean dressing or any clean cloth that is available to hold pressure on an open avulsion or degloving injury. The dressing will help it clot and stop the bleeding. Don't be afraid to put direct pressure on raw muscle or fat tissue. Even though the wound is open and raw, direct pressure is the best way to stop bleeding. Do not use a tourniquet unless the bleeding cannot be controlled and medical care will not be available for several hours.
3. Rinse the wound. Use water or saline solution to cleanse the wound. Sterile irrigation is the best. Know that cleaning the wound will restart the bleeding in many cases, and that's OK as long as the bleeding is minimal. If the bleeding was very hard to stop and you are concerned that it will be out of control if you rinse the wound, skip this step while you are waiting for professional help to arrive.
4. Replace the flap or bring separated tissue to the hospital. If the tissue (skin, fat, and muscle) is not completely torn away, replace the flap and cover the wound. If the tissue is completely separated from the person's body, collect it if it's available and bring it to the emergency department with you or give it to first responders when they arrive. 

Healing From an Avulsion

It takes time to heal from an avulsion injury. During your recovery, you may need to visit your healthcare provider often to have the wound dressing changed. They'll also check the wound to make sure you aren't having any complications, such as an infection.

You may also have instructions from your provider on the activity limitations you need to stick to so you can avoid making movements that could interfere with your healing.

Taking care of an avulsion wound at home includes:

• Keeping the skin clean. Your healthcare provider will let you know how long you should keep the wound dry. Afterwards, daily cleansing with soap and water is usually enough. Do not use harsh products like hydrogen peroxide because they can damage the delicate skin.
• Using bandages and/or barriers (like petroleum jelly). These help keep the wound covered and protected. 
• Following your provider’s instructions about when to change your dressings. For example, they might suggest you do this every day for the first few days or more often if they get dirty/damp.
• Looking for signs of infection. If you notice redness, swelling, or pus, or you have a fever, let your provider know right away. 
  

Summary

An avulsion is a serious injury where tissues from the body, including three layers of skin, are torn off. You will usually need immediate medical attention for an avulsion. Treatment may include skin grafts or reattaching the skin. Healing will take time, so follow your healthcare provider's instructions for keeping the wound clean, changing dressings, and watching for signs of infection.