Hematoma of the Lower Extremity: Operative Interventions in the Wound Clinic Setting

Terry Treadwell, MD, FACS, FAAWC


Wounds. 2022;34(3):90-93. 

In This Article

Case 2

A 91-year-old male sustained an injury to the left foot after dropping a quart-sized jar of soup on his foot. The patient presented to the ED where the foot was noted to be bruised. X-ray examinations were reported to be negative, and there was normal circulation in the foot. The patient was seen by a physician in the ED, an orthopedic surgeon, and his primary care physician; the patient said he was informed that the swelling of the foot as well as blistering and necrosis of the skin would heal without treatment. After 1 week, the patient presented to the wound clinic with increasing skin necrosis and swelling of the left foot (Figure 3A). A hematoma of the foot measuring 6 cm in diameter was found. The necrotic tissue was debrided, and the hematoma was evacuated under local anesthesia (Figure 3B). One month after starting treatment with ORC/collagen/silver, after presentation and evacuation of the hematoma, the patient developed cardiac problems requiring hospitalization. After hospital discharge 1 week later, the foot was healing well, but a stage 3 presacral pressure injury had developed. After 5 months of therapy with debridement and applications of ORC/collagen/silver dressings on both wounds, wound healing was achieved (Figure 3C).

Figure 3.

Case 2: wound of the left foot (A) at 1 week after injury; note the delayed skin necrosis. (B) Wound after the hematoma was evacuated. (C) Wound healed after 5 months of therapy.