Avulsion injury is the forceful peeling of skin and subcutaneous tissue from the deep or superficial surface of the deep fascia due to external forces such as wheels or apparatus drive belts, accompanied by varying degrees of soft tissue crushing injury. Skin avulsion injury is a more serious injury, divided into two categories of complete and incomplete avulsion; the latter is divided into prograde and retrograde avulsion injury. Hand skin avulsion injuries are often caused by inadvertent involvement in the manipulation of high-speed rotating lathes, or due to violent twisting and pulling. The classification of avulsion injuries are: 1, sheath type and flap type; 2, grinding type and avulsion type; 3, open and closed; 4, lamellar avulsion injury, set avulsion injury and submarine avulsion injury; 5, complete, incomplete and submarine three categories . First, the injury judgment: 1, systemic condition: more than half of the patients with large avulsion injuries occur traumatic shock. Large area of skin avulsion injuries must be measured after receiving blood pressure, pulse, respiration and other vital signs and urine volume. 2, combined injuries: the injuries are more complex, and it is easy to focus on the trauma of the body surface at the beginning when receiving, and it is easy to ignore the combined injuries. Therefore, the first whole body system examination, especially the combined cranial trauma and visceral injury, is more important than the tearing injury itself in the initial treatment. Missing diagnosis is bound to delay the treatment of patients, and even cause life-threatening consequences. 3, deep tissue injury: deep bone, joint, vascular, nerve, tendon and muscle examination cannot be ignored. About two-thirds of large skin avulsion injuries of the lower extremities have muscle contusions, and half of the cases combined with bone and joint injuries. When examining avulsion injuries, we should explore the deep tissue injuries and perform auxiliary examinations such as X-ray, B-ultrasound and CT when necessary. If the preoperative diagnosis is not clear, intraoperative discovery after changing the program may be in a passive situation. 4, skin avulsion injury examination: figure out the site, scope, depth of avulsion, area and degree of injury, especially the depth of epidermal contusion, the degree of wound contamination, vascular damage and bleeding. 5, the judgment of the latent skin avulsion injury: there are small wounds, visible broken fat particles gushing out with the blood. If there is a suspicion of submerged avulsion injury, also available thick needle puncture or ultrasonic examination, if necessary, surgical exploration. 6, skin flap blood flow judgment: naked eye observation of skin color and congestion reaction, touching by hand or measuring skin temperature with a skin thermometer, observing the blood seepage from the trauma edge or piercing the skin with a needle to observe the bleeding situation. The treatment principles for avulsion wounds are as follows: 1. First aid: preliminary injury diagnosis, pressure dressing, blood and fluid transfusion, correction of hemorrhagic shock, pain relief, application of tetanus antitoxin and antibiotics. 2. 2, debridement: repeatedly flush the wound, remove foreign bodies and necrotic tissue, and stop bleeding. The blood circulation of the avulsed tissues should be judged, and for the avulsed tissues without blood flow, they should be excised and the tissues with blood flow should be preserved by all means. 3.Free skin implant: source of donor skin slice: reverse skin extraction, skin extraction, thickness of skin slice: thick to medium thick skin implantation method: sieve or mesh. Treatment of reverse skin retrieval: use 0.05% Neosporin, soak the whole avulsed tissue with subcutaneous fat for fifteen minutes before reverse skin retrieval 4. Perforation and drainage, avulsed tissue back implantation: conservative treatment method can be considered after examination to confirm that the blood circulation of the skin is still good. For skin avulsion wounds of body surface organs such as palms, soles and auricles, if the skin has blood flow and there is still hope for survival, replantation should be pursued. The focus of debridement is to remove the blood and tissue debris in the avulsion cavity, make more holes along the long axis of the limb, place negative pressure drainage tubes or cigarette drainage, and apply appropriate pressure bandages. 5, anastomosis of the avulsed flap replantation: there is available anastomosis of the blood vessels is the key to replantation survival. Our burn plastic surgery department received and participated in the treatment of a number of cases of skin avulsion injuries, involving the scalp, face, five senses and perineum. We have learned that the prognosis is directly influenced by the way the patient is treated on the spot and in the emergency. If the emergency treatment is improper and the skin is not properly utilized, it will cause skin necrosis and infection, prolong the course of the disease, lead to functional impairment, increase the patient’s pain and even endanger their lives. Early and proper management, standardized reuse of the avulsed skin, and systemic supportive therapy are the three key factors to improve the outcome.