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Pretibial hematomas – A real-world single-center study

We analyzed treatment, outcome, and risk factors for skin necrosis of 60 patients aged ≥65 years treated for a pretibial hematoma in the province of Kymenlaakso, Finland, between 2015 and 2019. Reviewing patients’ medical records revealed two cohorts with distinct trajectories in outcome. By compari...

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Detalles Bibliográficos
Autores principales: Seppälä, T., Grünthal, V., Koljonen, V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8938884/
https://www.ncbi.nlm.nih.gov/pubmed/35330747
http://dx.doi.org/10.1016/j.jpra.2022.01.001
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author Seppälä, T.
Grünthal, V.
Koljonen, V.
author_facet Seppälä, T.
Grünthal, V.
Koljonen, V.
author_sort Seppälä, T.
collection PubMed
description We analyzed treatment, outcome, and risk factors for skin necrosis of 60 patients aged ≥65 years treated for a pretibial hematoma in the province of Kymenlaakso, Finland, between 2015 and 2019. Reviewing patients’ medical records revealed two cohorts with distinct trajectories in outcome. By comparing the cohorts, we were able to discover factors associated with the prognosis for generating skin necrosis and the need for operative treatment. Thirty-five (58.3%) patients healed without any management, and 25 (41.7%) patients were treated with hematoma evacuation, mostly for having generated skin necrosis (72%). Among operatively treated patients’ descriptions, such as “parchment skin” and “poor skin quality” were observed frequently (80%) in the medical records. This pathology, dermatoporosis, was statistically significant (p<0.0001) among patients with a complicated outcome of a pretibial hematoma. In addition to dermatoporosis, patients with hematoma evacuation were more fragile having a higher Charlson comorbidity index (p = 0.005), a greater need for a walking aid (p = 0.0002), and overall compromised independency (p = 0.033). Hospitalization and rehabilitation were prolonged in the operatively treated cohort, 6.4 days vs. 2 days, respectively. We recorded a delay in the diagnosis and hematoma evacuation (mean 6, range 0–51 days). In addition, six (10%) patients were misdiagnosed for having erysipelas or deep vein thrombosis indicating that pretibial hematomas are not recognized. Skin quality should be documented, and prompt surgical hematoma evacuation should be executed in fragile patients with dermatoporosis. This could prevent skin necrosis and the further need of wound care or surgical care, long hospitalization, and rehabilitation periods.
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spelling pubmed-89388842022-03-23 Pretibial hematomas – A real-world single-center study Seppälä, T. Grünthal, V. Koljonen, V. JPRAS Open Original Article We analyzed treatment, outcome, and risk factors for skin necrosis of 60 patients aged ≥65 years treated for a pretibial hematoma in the province of Kymenlaakso, Finland, between 2015 and 2019. Reviewing patients’ medical records revealed two cohorts with distinct trajectories in outcome. By comparing the cohorts, we were able to discover factors associated with the prognosis for generating skin necrosis and the need for operative treatment. Thirty-five (58.3%) patients healed without any management, and 25 (41.7%) patients were treated with hematoma evacuation, mostly for having generated skin necrosis (72%). Among operatively treated patients’ descriptions, such as “parchment skin” and “poor skin quality” were observed frequently (80%) in the medical records. This pathology, dermatoporosis, was statistically significant (p<0.0001) among patients with a complicated outcome of a pretibial hematoma. In addition to dermatoporosis, patients with hematoma evacuation were more fragile having a higher Charlson comorbidity index (p = 0.005), a greater need for a walking aid (p = 0.0002), and overall compromised independency (p = 0.033). Hospitalization and rehabilitation were prolonged in the operatively treated cohort, 6.4 days vs. 2 days, respectively. We recorded a delay in the diagnosis and hematoma evacuation (mean 6, range 0–51 days). In addition, six (10%) patients were misdiagnosed for having erysipelas or deep vein thrombosis indicating that pretibial hematomas are not recognized. Skin quality should be documented, and prompt surgical hematoma evacuation should be executed in fragile patients with dermatoporosis. This could prevent skin necrosis and the further need of wound care or surgical care, long hospitalization, and rehabilitation periods. Elsevier 2022-02-24 /pmc/articles/PMC8938884/ /pubmed/35330747 http://dx.doi.org/10.1016/j.jpra.2022.01.001 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Seppälä, T.
Grünthal, V.
Koljonen, V.
Pretibial hematomas – A real-world single-center study
title Pretibial hematomas – A real-world single-center study
title_full Pretibial hematomas – A real-world single-center study
title_fullStr Pretibial hematomas – A real-world single-center study
title_full_unstemmed Pretibial hematomas – A real-world single-center study
title_short Pretibial hematomas – A real-world single-center study
title_sort pretibial hematomas – a real-world single-center study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8938884/
https://www.ncbi.nlm.nih.gov/pubmed/35330747
http://dx.doi.org/10.1016/j.jpra.2022.01.001
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