A kick in the shins: The financial impact of uncontrolled warfarin use in pre-tibial haematomas

Thomson, W.L.; Pujol-Nicolas, A.; Tahir, Adnan; Siddiqui, H.

doi:10.1016/j.injury.2012.07.007

Cited by 14 publications

(31 citation statements)

References 6 publications

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“…They are of pressing concern in the elderly and infirm owing to decreased dermal collagen integrity resulting in friable skin, which exacerbates injury from trivial trauma. 1 Underlying haematomas often co-exist and are potentiated by anticoagulant medications such as warfarin, 2 which compromises surrounding healthy tissue by inducing local tissue ischemia via pressure effects and the production of reactive free radicals. 3 Many underlying comorbidities such as diabetes mellitus, peripheral oedema, peripheral vascular disease and corticosteroid use have all been associated with decreased skin integrity through oxidative stress and matrix-metalloproteinase mechanisms.…”

Section: Introductionmentioning

confidence: 99%

“…7 The financial impact is significant, with an estimated £3,500 spent per acute admission. 2 Furthermore, variations in management in primary and secondary care have led to complicated and compromised clinical outcomes, with many patients going on to require plastic surgery and tissue viability services, wound debridement, grafting and negative-pressure dressings. This negatively impacts on patient morbidity.…”

Section: Introductionmentioning

confidence: 99%

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The management of pretibial lacerations

Singh

Khatib

Elfaki

et al. 2017

annals

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Introduction Pretibial lacerations are common injuries, often presenting in the elderly and infirm. Unclear management pathways often result in inappropriate care. We identify patient demographics, morbidity risk factors, injury severity and management options. Materials and methods This retrospective study involved analysing databases and hardcopy notes for patients admitted with pretibial lacerations to Addenbrooke's Hospital, January to December 2012. Microsoft Excel and Fishers exact test were used to analyse the data with a P-value of less than 0.05 representative of statistical significance. Information on patient demographics, site of lesion, preoperative symptoms, management, operative details and clinical outcomes were collected. Results A total of 36 patients were identified; the mean age was 79 years (± 16 years, 1 standard deviation) with a three to two female to male preponderance; 57% of injuries were caused by mechanical fall, 33% traumatic blunt impact and 7% road traffic accidents. American Society of Anesthesiologists physical status classification was 43% level III, 40% II, 9% I and 9% IV. Dunkin classification of severity was 33% grade III, 30% grade I, 24% grade IV and 12% grade II. Median inpatient duration was 11 days for surgically managed compared with 15 days for conservatively managed patients. Discussion Pretibial lacerations tend to affect the elderly. Management is compounded by polypharmacy and comorbidities. If inadequately managed, such injuries can adopt characteristics of chronic wounds, with lengthy inpatient stays. Surgical intervention may be appropriate where injuries are severe and the patient stable enough for theatre. Conclusions We believe that surgical management with autologous tissue repair, with minimal delay between presentation and theatre, is warranted for extensive injuries wherever possible, with conservative management used for predominantly less extensive pretibial lacerations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The management of pretibial lacerations

Singh

Khatib

Elfaki

et al. 2017

annals

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“…To our knowledge, DDH usually arises immediately after an injury, often a minor one (2,5,(7)(8)(9). Data concerning the prevalence and incidence of DDH are rare.…”

Section: Discussionmentioning

confidence: 99%

Rapidly Evolving Deep Dissecting Hematoma With Sudden Onset, Developed One Month After A Minimal Trauma.

Hamdan¹,

Zwetyenga²,

Macheboeuf³

et al. 2021

Preprint

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Background: Deep dissecting hematoma is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. Case presentation: We report the admission of a 70-year-old woman to the emergency department of our hospital for the onset of a deep dissecting hematoma one month after a negligible trauma in the right leg, complicating secondary iatrogenic dermatoporosis. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Surgical debridement and hematoma drainage were performed due to rapid horizontal extension of the hematoma and unresolved pain, with the operative report confirming the diagnosis. Conclusion: This observation emphasises that in patients with severe dermatoporosis, several weeks can elapse between a minor impact and the sudden development of a limb-threatening deep dissecting hematoma.

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“…Uncommon aetiologies should not be overlooked [6,9]. DDH is the most serious complication of dermatoporosis, usually arising immediately after an injury, often a minor one [2,5,[7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the extension, age and whether or not the haematoma is closed, Fennira et al described four types of DDH (early closed type, advanced closed, advanced type with necrosis and open type) and highlighted rapid increase in the volume and extent of the haematoma as signs of severity [2]. Furthermore, although it has been reported under direct oral anticoagulants [9], the association of skin frailty and VKA -for which cutaneous complications are well documented ( uindione or warfarin) [8] -or antiplatelet drugs [4] remains the classical situation where DDH has been observed [1,5].…”

Section: Discussionmentioning

confidence: 99%

Rapidly Spreading Deep Dissecting Hematoma Occurring One Month After A Minor Trauma: A Case Report.

Hamdan

Zwetyenga

Macheboeuf

et al. 2021

Preprint

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Background: Deep dissecting hematoma (DDH) is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. A delay of several weeks between the appearance of a superficial haematoma following a minor trauma and its sudden decompensation into a rapidly spreading DDH has been scarcely mentioned in the medical literature. Case presentation: We report the admission of a 70-year-old woman under anticoagulation to the emergency department of our hospital for the sudden appearance of a rapidly evolving hematoma one month after a negligible trauma to the right leg. A complete skin examination revealed clinical signs (spontaneous superficial skin haematomas, lacerations, wrinkles, stellate pseudo-scars) of advanced dermatoporosis, especially on the forearms. The initial biological testing disclosed an International Normalized Ratio of 3.15. The clinical aspect of the haematoma, its rapid extension and the cutaneous signs of dermatoporosis on the forearms allowed the diagnosis of DDH. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Due the extent of the lesion and the risk of extended skin necrosis, surgical debridement and hematoma drainage were performed. The operative report confirmed the diagnosis of DDH. Wound healing was obtained spontaneously after three months. Conclusion: DDH is the most serious complication of dermatoporosis. Given its rapid horizontal extension and the risk of skin necrosis it induces, DDH is a medical-surgical emergency and must be diagnosed early. This observation emphasises that in patients with severe dermatoporosis, on the occasion of a Vitamin K Antagonist overdose, a limb-threatening DDH can develop suddenly, even several weeks after a minor impact.

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A kick in the shins: The financial impact of uncontrolled warfarin use in pre-tibial haematomas

Cited by 14 publications

References 6 publications

The management of pretibial lacerations

The management of pretibial lacerations

Rapidly Evolving Deep Dissecting Hematoma With Sudden Onset, Developed One Month After A Minimal Trauma.

Rapidly Spreading Deep Dissecting Hematoma Occurring One Month After A Minor Trauma: A Case Report.

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