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

Terry Treadwell, MD, FACS, FAAWC

Disclosures

Wounds. 2022;34(3):90-93. 

In This Article

Discussion

Hematomas of the extremity following operative intervention or trauma may occur in patients with thinner skin (patients >65 years, patients on corticosteroids) and those taking any variety of anticoagulant medications.[1] Hematomas should not be taken lightly because their presence in a wound or site of injury increases the chance of infection and worsening of the tissue damage.[1,2]

Pressure on the surrounding tissues from the hematoma (Figure 4) can be significant. The patient in Figure 4 had a tight hematoma of the right leg after falling. At presentation, the leg was determined to be bruised, but, according to the patient, the treating clinician said there was no need to be concerned. The wound image captured 2 weeks after injury demonstrates the effect of the pressure of the hematoma on the overlying skin, resulting in necrosis of significant areas of the skin (Figure 4). There is concern that patients may experience continued bleeding into a hematoma, especially those taking anticoagulants like the patient in case 1.

Figure 4.

Leg wound showing massive skin necrosis 2 weeks after injury with an untreated hematoma.

Figure 5 illustrates a hematoma that developed in a repaired laceration. To avoid potential infection and delayed wound healing, hematomas developing in operative wounds (Figure 6) should not be ignored.

Figure 5.

Leg wound irrigated and closed in the emergency department 7 days before presentation to the wound clinic. A large (measuring 24cm in length) wound hematoma was identified and evacuated.

Figure 6.

Postop hematoma of operative wound of the left ankle following evacuation of the hematoma.

It has been shown that blood breakdown products and iron in the tissues can result in significant tissue damage if not treated, further supporting the need to evacuate these blood collections.[1–4] Long-term complications as seen in Figure 1 and other more serious ones (eg, cases presented herein and those in the references) need to be avoided if possible.[1,5,6]

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