Hair Tug Test: A Simple Clinical Method to Assess Skin Viability after Degloving Injury

Degloving injuries are common in road traffic accidents, especially involving the lower limb. Determining the viability of an avulsed flap is often difficult during initial assessment.

Early recognition of nonviable areas can aid in reducing the number of debridements, reducing the chances of infection and sepsis and, thus, reduce the hospital stay and aid in early recovery. Further, skin from such nonviable areas can be harvested as a skin graft for coverage of the defect before the avulsed flap becomes necrosed.[1]

There are few clinical methods to determine flap viability like assessment of bleeding and its color on needle prick, which may not be reliable and is subject to interobserver variability.

Other techniques, such as surface fluorometry, laser Doppler, and whole body fluorescence, involve sophisticated equipment and are not practical for assessing the viability of an acutely injured flap. They are more suited to monitor flap viability postoperatively.[1]

Here we describe another clinical method to determine flap viability, the hair tug test, which the authors has used over the past 18 years and found it consistently reliable, and which is employed routinely at our center now.

Publication History

Article published online:
22 April 2020

• References

• 1 Lim H, Han DH, Lee IJ, Park MC. A simple strategy in avulsion flap injury: prediction of flap viability using wood’s lamp illumination and resurfacing with a full-thickness skin graft. Arch Plast Surg 2014; 41 (02) 126-132
• 2 Zeligowski AA, Ziv I. How to harvest skin graft from the avulsed flap in degloving injuries. Ann Plast Surg 1987; 19 (01) 89-90