his article is about avulsion injuries other than Avulsion fractures.

For other uses, see Avulsion

(disambiguation).
In medicine, an avulsion is an injury in which a body structure is torn off by either trauma or surgery
(from the Latin avellere, meaning "to tear off").[1] The term most commonly refers to a surface trauma
where all layers of the skin have been torn away, exposing the underlying structures
(i.e., subcutaneous tissue, muscle, tendons, or bone). This is similar to an abrasion but more severe,
as body parts such as an eyelid or an ear can be partially or fully detached from the body.

Skin avulsions[edit]
The most common avulsion injury, skin avulsions usually occur during motor vehicle collisions. The
severity of avulsion ranges from skin flaps (minor) to degloving (moderate) and amputation of a
finger or limb (severe). Suprafascial avulsions are those in which the depth of the removed skin
reaches the subcutaneous tissue layer, while subfascial avulsions extend deeper than the
subcutaneous layer.[2] Small suprafascial avulsions can be repaired by suturing, but most avulsions
require skin grafts or reconstructive surgery.

Rock climbing[edit]
In rock climbing, a "flapper" is an injury in which parts of the skin are torn off, resulting in a loose flap
of skin on the fingers.[3] This is usually the result of friction forces between the climber's fingers and
the holds, arising when the climber slips off a hold.
To fix this injury and to be able to continue climbing, many climbers will apply sports tape to the
flapped finger to cover up the sensitive area of broken skin. Some climbers may even use super-
glue to adhere the loose skin back to the finger.

Ear avulsions[edit]
The ear is particularly vulnerable to avulsion injuries because of its position on the side of the head.
[4]
 The most common cause of ear avulsions is human bites, followed by falls, motor vehicle
collisions, and dog bites.[4] A partially avulsed ear can be reattached
through suturing or microvascular surgery, depending on the severity of the injury.[5][6] Microvascular
surgery can also be used to reattach a completely avulsed ear,[7][8][9] but its success rate is lower
because of the need for venous drainage.[10][11] The ear can also
be reconstructed with cartilage and skin grafts[10] or an external ear prosthesis can be made by
an anaplastologist.

Eyelid avulsions[edit]
Eyelid avulsions are uncommon,[12] but can be caused by motor vehicle collisions,[13] dog bites,[14][15] or
human bites.[14] Eyelid avulsions are repaired by suturing after a CT scan is performed to determine
where damage to the muscles, nerves, and blood vessels of the eyelid has occurred.[13] More severe
injuries require reconstruction, however, this usually results in some loss of function and subsequent
surgeries may be necessary to improve structure and function.[16] Microvascular surgery is another
method of repair but is rarely used to treat eye avulsions.[15] Sometimes botulinum toxin is injected
into the eyelid to paralyze the muscles while the eyelid heals.[13]

Nail avulsions[edit]
Trauma to the nail can cause the nail plate to be torn from the nail bed.[17] Unlike other types of
avulsion, when a nail is lost, it is not typically reattached. Following the loss of the nail, the nail bed
forms a germinal layer which hardens as the cells acquire keratin and becomes a new nail.[18] Until
this layer has formed, the exposed nail bed is highly sensitive, and is typically covered with a non-
adherent dressing, as an ordinary dressing will stick to the nail bed and cause pain upon removal.
[19]
 In the average person, fingernails require 3 to 6 months to regrow completely, while toenails
require 12 to 18 months.

Brachial plexus avulsions[edit]

In brachial plexus avulsions, the brachial plexus (a bundle of nerves that communicates signals
between the spine and the arms, shoulders, and hands) is torn from its attachment to the spinal
cord. One common cause of brachial plexus avulsions is when a baby's shoulders rotate in the birth
canal during delivery, which causes the brachial plexus to stretch and tear.[20] It occurs in 1-2 out of
every 1,000 births.[21] Shoulder trauma during motor vehicle collisions is another common cause of
brachial plexus avulsions.[22] Detachment of the nerves can cause pain and loss of function in the
arms, shoulders, and hands. Neuropathic pain can be treated with medication, but it is only through
surgical reattachment or nerve grafts that function can be restored.[22] For intractable pain, a
procedure called dorsal root entry zone (DREZ) lesioning can be effective.[22]

Tooth avulsions[edit]
During a tooth avulsion, a tooth is completely or partially (such that the dental pulp is exposed)
detached from its socket. Secondary (permanent) teeth can be replaced and stabilised by a dentist.
[23]
 Primary (baby) teeth are not replaced because they tend to become infected and to interfere with
the growth of the secondary teeth.[23] A completely avulsed tooth that is replaced within one hour of
the injury can be permanently retained.[23] The long-term retention rate decreases as the time that the
tooth is detached increases, and eventually root resorption makes replacement of the tooth
impossible.[23] To minimize damage to the root, the tooth should be kept in milk or sterile saline while
it is outside the mouth.[23][24]

Periosteal avulsions[edit]
During a periosteal avulsion, the periosteum (a fibrous layer that surrounds a bone) detaches the
bone's surface. An example of a periosteal avulsion is an ALPSA (anterior labral periosteal sleeve
avulsion).

Surgical avulsions[edit]
An avulsion is sometimes performed surgically to relieve symptoms of a disorder, or to prevent a
chronic condition from recurring. Small incision avulsion (also called ambulatory phlebectomy) is
used to remove varicose veins from the legs in disorders such as chronic venous insufficiency.[25] A
nail avulsion is performed to remove all or part of a chronic ingrown nail.[26] Facial nerve avulsion is
used to treat the involuntary twitching involved in benign essential blepharospasm.[27][28] However, it
often requires additional surgeries to retain function[27] and botulinum toxin injections have been
shown to be more effective than surgical avulsions in treating benign essential blepharospasm, while
causing fewer complications.[28]