Décollement (medicine)

Classification according to ICD-10
S00-T98	Injuries, poisoning and certain other consequences of external causes
Div.	Additional key "Soft tissue damage I. ... III. Degree ... “under each injured organ system
ICD-10 online (WHO version 2019)

Under décollement ( Franz. , Shear ', décoller , "detach") is the separation of the skin from the subcutaneous fatty tissue ( subcutaneous tissue ) and / or the muscle fascia by external forces. Décollement is a form of skin abrasion in which the skin is sheared from the underlying tissue without tearing the skin.

Emergence

The décollement is created by squeezing force with simultaneous displacement of the skin on its base by tangential (shearing) forces. As a result, the subcutaneous fatty tissue is overstretched to such an extent that it tears away from the inside of the skin and thus the blood flow and the nerve supply of the skin from the base in the affected area is lost. If the skin tears, as in décollement of the scalp, the skin flap is fed only via a stalk. If there is a gross disproportion from the stem to the lobe, the latter will die off if left untreated.

Décollement is often an accompanying injury to fractures of the extremities, but it also occurs as an independent injury and is then often underestimated in its severity. A typical course of an accident is when a stone falls from the hanging wall of miners or when a pedestrian is hit or rolled over by a motor vehicle.

Risks

If left untreated, décollement usually leads to extensive skin necrosis , as the hematoma between the skin and subcutis prevents capillaries from sprouting into the skin. In addition, there is a risk of bacterial infection , especially if there are open skin injuries . The often simultaneous bruising of the underlying muscles harbors the risk of a compartment syndrome . In extreme cases, there is a risk of limb loss.

treatment

Operated decollement injury on the knee

The treatment is usually carried out surgically: areas of skin that have already been irrevocably damaged are removed, the hematoma under the skin that is still intact is cleared and drained, destroyed subcutaneous tissue is also removed, the detached skin is fixed to the subcutis with internal "stitching sutures". As a result, skin grafts are often required. Accompanying injuries, v. a. Fractures must also be treated very carefully.

Healing and long-term effects

The décollement only heals without consequences if it is of minor extent and has been treated effectively at an early stage. Otherwise, extensive scar plates often remain, resulting in scar contractures with extensive functional disorders, e.g. B. movement restrictions can occur.

swell

• H.-P. Scharf, A. Rüter, T. Pohlemann: Orthopedics and trauma surgery. Verlag Urban & Fischer bei Elsevier, Munich 2008, ISBN 3-437-24400-0 , p. 125

Individual evidence

1. ↑ Wolfgang Schwerd: Types of mechanical force, their forms of expression and consequences. In: Wolfgang Schwerd (Hrsg.): Brief textbook of forensic medicine for doctors and lawyers. Deutscher Ärzte-Verlag, Cologne-Lövenich, 3rd, revised and expanded edition 1979, ISBN 3-7691-0050-6 , pp. 31–53, here: pp. 35 f.
2. ↑ D. Metter: The décollement as a collision injury. In: International Journal of Legal Medicine. Volume 85, Number 3, 1980. pp. 211-219. doi : 10.1007 / BF02116322

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !