Avulsion Wound: Descriptions and Treatments

Trauma can cause a wide variety of wounds with different degrees of severity. One common wound category that healthcare providers and wound care specialists encounter are avulsion wounds.

To learn more about avulsion wounds, we spoke with Preston “Chip” Rich, MD, MBA, Medical Director of Trauma Services at MemorialCare’s Long Beach Medical Center and Miller Children’s and Women’s Hospital in Long Beach, California.

As an attending staff member at his facility, he specializes in trauma surgery, treating victims of trauma and those requiring intensive critical care from their injuries. Rich and his colleagues see a spectrum of injuries, including complicated avulsion injuries.

Defining the avulsion wound

When providing wound care, it’s important to determine what type of wound you’re treating.

Rich defined an avulsion injury as, “One in which any body structure is sheared or torn off the body.” He added that with avulsion wounds and injuries, tissue is separated from the body. And that avulsion means all the layers of skin and fat are separated from deeper structures.

Additionally, an avulsion can expose and separate from other deeper structures, such as fascia, tendons, muscles, and bones. These deeper parts can also be torn from the body during the trauma too, he said.

In some instances, people may confuse an avulsion with an abrasion. Rich described the difference between the two types. “With an abrasion, lots of skin can be torn away from the body. With an avulsion, tearing also involves the tearing of deeper structures, such as fat, fascia, tendon, muscle, and/or bone.”

Where avulsions occur

An avulsion wound can occur in any area of the body — and to any body part, said Rich. “The ears are one common location where avulsions are seen,” he said. He highlighted that dog bites are one of the more common incidents of avulsion injuries that occur to the face, arms, and legs.

In addition, clusters of avulsion injuries can occur because of factors prevalent in certain geographic locations. For example, areas where a lot of parachuting takes place like Fort Bragg in North Carolina, a U.S. Army base and home of the U.S. Army’s Special Forces and Airborne Units. Before living in Long Beach, California, Rich lived near Fort Bragg and saw parachute-specific avulsion injuries on a routine basis.

According to Rich, one mechanism of injury when parachuting is when the parachutist’s arms get caught in the shrouds (cords) of a parachute. “This can cause a degloving avulsion wound to an arm or both arms,” he said. “With a degloving avulsion, the tissue is rolled off in a large piece.” Adding that a degloving wound is like peeling off a pair of gloves from your hands.

Rich added that another parachute-related avulsion wound can happen at the shoulder and brachial plexus. “With this type of avulsion injury, the nerves of the brachial plexus are pulled of the spinal cord.” But the most severe form of an avulsion is amputation, according to Rich. “With an amputation, an entire limb of torn from the body,” he said.

Challenges

Avulsion wounds can be difficult to treat for several reasons, said Rich. “When tissue is peeled off, it means the area suffered extensive trauma and decreased blood flow due to damaged blood vessels,” he said.

Another challenge is the high risk for infection. “These are dirty wounds due to the various traumatic mechanisms of injury,” he said. Avulsion wounds can also create a loss of function to a limb or another area of the body. And according to Rich, this can result from reduced blood flow, nerve damage, and amputation.

Because of their complexity and severity, avulsion wounds can also have more serious and life-threatening risks. One study noted that challenges with avulsions can also lead to shock or even death. Understanding the challenges these wounds can encounter and knowing ways to avoid them is critical.

The proper treatment

Proper treatment is crucial to facilitate avulsion wound healing. Treatments vary and may involve several methods to implement, as indicated.

Rich, who is board certified in both general surgery and surgical critical care, mentioned one type of surgical intervention performed with avulsions is to reattach severed blood vessels. This approach aims to improve blood flow and to reattach nerves to injured areas. “Adequate blood flow is essential for healing and functioning,” he said.

Surgical debridement is another treatment utilized for avulsion wounds. “Cleaning and irrigating wounds is needed to reduce the risk of infection and remove tissue that is too damaged to heal,” said Rich. “Determining what tissue can be saved and what tissue needs to be removed is imperative for healing.”

Post-surgical wound care is also an important part of treating avulsion wounds and injuries, according to Rich. “Utilizing teams of MDs, RNs, and other wound care certified professionals is essential,” he said.

Some wound care treatments Rich highlighted are:

• Vacuum-assisted negative pressure
• Skin grafts (common with burn wounds)
• Hyperbaric chamber (to increase the concentration of O2 to the wound)
• Utilizing the appropriate dressings
• Growth factors
• Skin substrates

Wound care is a broad and complex topic, and research is ongoing, said Rich. There is not a one-size-fits-all process for treatment and healing. However, to optimize avulsion wound healing, Rich said it’s important to use dressings and products in the way they are indicated, as well as understand when and how to use them.

In the end, the goal for patients is to not only heal but to also achieve the highest level of functioning possible. This can involve the use of additional specialties, such as occupational therapy (OT) and physical therapy (PT). Referencing his example of a paratrooper who severed their brachial plexus, Rich said, “Their nerves may not fully heal. However, rehabilitation and OT can help the patient reach an increased level of functioning.”