George Wallace said:
Could you go on to explain the affects of 'blast' or 'explosive events' that result in "degloving"?
For instance, when bodies are found 'naked' at the site of an IED or other 'explosive event', and what traumatic event resulted in death or dismemberment? Degloving, is more often going to be the result of a 'blast' in a Cbt situation, than a ring caught on an object. How serious and how often would that be the case?
I'll take a stab at this, though a currently serving medic may be more up to date. I may be stepping outside my lane here because I am not a physician, it has been several years since I have seen any 'blast injuries' (landmines) and even then I was no longer clinical (or active military), though like many I continue to have a interest in those 'gee whiz, isn't that gross but neat' kind of injuries. Those who recall one particular scene in that old training film at CFMSS
Army Medicine in Vietnam will immediately know what I'm talking about. Degloving injuries that present in a classical manner fall into that category.
When you say "naked" I'm assuming that you mean the casualty's condition includes soft tissue injuries of the extremities in which the tissues have been 'peeled' off exposing a relatively intact skeletal structure (or other subcutaneous parts) vice a casualty whose clothing has been blown off. The causative agent of the injury could be the blast pressure or projectiles secondary to the blast. As was stated above such injuries result when shearing force is applied with sufficient power to cause tissue planes to separate. In other words, the harder parts stay put, and the softer parts tear away. Blast injuries, however, are more than 'degloving'.
http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/MilitaryMedicine/Blast%20Injuries/BlastInjuriesRecognitionandManagement.htm
High-explosive (HE), thermobaric, and nuclear detonations cause extreme compression of molecules in surrounding air or water creating thin bands of locally high overpressure, which are propagated away from the origin of the explosion as a blast shock wave. Most casualties within the injury radius of a HE detonation will have common penetrating (Figure 1 & Figure 2), blunt, and burn (Figure 3) injuries managed no differently than similar non-blast trauma.
When the blast wave arrives at the surface of an object (vehicle, structure, or human body), it is transmitted into that object as a stress wave (Figure 4). As the blast wave separates from the stress wave due to the latter moving slower through objects than the blast wave moves around them, pressure differentials cause forces that accelerate surfaces (Figure 5). When transmitted into the human body, the shock wave causes stress-induced tears at air-tissue interfaces (Figure 6), which result in internal bleeding, weakening of tissue resistance to additional insults, and possible rupture with escape of air from the respiratory tract or spillage of gastrointestinal (GI) contents.
Massive hemoptysis can compromise the airway. Management of any associated penetrating, blunt, and thermal trauma will not be discussed in this chapter.
As for the frequency that degloving is associated with blast injuries, I have not been able to locate any related statistics, however some tables in the current Emergency War Surgery Handbook list both blast and degloving.
http://www.usaisr.amedd.army.mil/ewsh/Chp3Triage.pdf
Data from more recent American combat operations in Iraq (OIF) and Afghanistan (OEF), 2003–2004, indicating the spectrum of injury type (Table 3-1), mechanism (Table 3-2), and anatomical location (Table 3-3) are found below.
The examples of ring fingers and hands are brought up often because that's what is more often seen by first responders and it is what first comes to mind when 'degloving' is mentioned. The examples I gave in my previous post all occurred in a military setting and (with the exception of the Egyptian) all occurred in the field, on exercise during tactical scenarios. The pers involved IIRC were armoured, infantry and MSE. While DNBI may not be the scourge of military operations that they once were, they still account for a significant proportion of military medical workload.
The term 'degloving' seems to be applied more often now to avulsion injuries (regardless of anatomical location and cause) than in the past. As an example of how use of the term 'degloving' seems to be expanding, I recall an article (with some neat pictures) by an RAMC surgeon in Iraq who used it to describe the condition of an Iraqi sniper's lower right arm following being shot (by British soldier) with the round entering at the trigger finger and exiting farther up the arm but with most of the soft tissue along the way displaced.
In conclusion, since I gave the 'finger' before (pun intended) here's something else.
Calling over a first aider......aren't we all supposed to be first aid trained? We have been told they want us to get the TCCC course as personnel have been looking to the PMeds (cap badge issue :
) for medical treatment. I can only wonder if the same applies to HCAs vs. MOs??? ???
