Background: Pretibial lacerations remain one of the commonest problems in plastic surgery. There is still no evidence of superiority of either a conservative or surgical approach for their management, nor any documentation regarding patients' performance following each approach. Methods: We conducted a retrospective study of all patients treated for pretibial lacerations/haematomas in our unit, from May 2013 till April 2014 who were offered surgical or conservative management. Conservative management included washout of wound and application of non-adhesive dressings; the patients were discharged home on the same day and followed up in dressing clinic. The Eastern Cooperative Oncology Group score was used to assess patients' well-being during healing time. Results: There were 38 patients; 21 opted for conservative management and 17 for skin grafting, after consultation. Overall, 66% of conservatively managed wounds were completely healed and patients were discharged. Mean healing time was 66.28 (13-172) days and required 3.43 (1-8) visits to the unit. In the surgically managed group, 88% of the patients had their wounds completely healed with a mean healing time of 69.5 (14-147) days and 5.87 (2-11) visits to the unit required. Of the conservatively managed patients, 55.6% scored 0 on the Eastern Cooperative Oncology Group scale, denoting fine health, while only 7.6% of the surgically managed patients scored zero. In total, 77.8% of the conservatively managed patients reported they would not have a chosen a skin graft if given the choice again. Conclusion: This study shows that satisfactory healing of pretibial lacerations may be achieved without surgical intervention in a high-risk group of patients, who reported good overall performance during healing time.