Deep dissecting haematoma in patients with dermatoporosis: implications for home nursing

Abstract

Dermatoporosis is a chronic cutaneous insufficiency/fragility syndrome with a high prevalence in older adults. Dermatoporotic skin becomes thin and fragile and tends to tear. It may lead to deep dissecting haematomas (DDHs) as a final stage of dermatoporosis, which is a clinical emergency. Management can be challenging, as patients with lower-limb haematomas are frequently older and affected by multiple comorbidities, or are probably on medications that negatively influence wound healing. This article describes the essential role of nurses in prevention, early recognition and wound management of DDHs in patients with dermatoporosis.

Rapidly spreading deep dissecting hematoma occurring 1 month after a minor trauma: A case report

“…The treatment of DDH comprises an invasive procedure (deep incision or surgical debridement) followed by conservative treatments. 3 , 4 , 9 Negative wound pressure therapy (NWPT) is recommended by some authors when skin grafting is being considered, 9 and the majority of articles on DDH mention the use of NWPT, 3 , 10 – 12 despite the low level of evidence supporting its value. 13 , 14 Post-operative wound management was limited to local care and dressings in only two reported DDH cases.…”

“…4 , 9 , 10 , 11 , 16 The signs of dermatoporosis and its complications, such as DDH, must also be early recognized by caregivers, carer, and patients affected by dermatoporosis, because the earlier the hematoma is removed, the less likely it is that the patient will sustain severe skin damage. 4 , 9 …”

“…Management of severe dermatoporosis involves prevention, particularly against trauma in the population identified as being at risk of DDH, and entails the risk of falls (by adapting furniture in the home, layout of the carpets), visual disorders' correction, and lower limbs' protection. 4,9,10,11,16 The signs of dermatoporosis and its complications, such as DDH, must also be early recognized by caregivers, carer, and patients affected by dermatoporosis, because the earlier the hematoma is removed, the less likely it is that the patient will sustain severe skin damage. 4,9 Although it has been reported under direct oral anticoagulants, the association of skin frailty and VKA-for which cutaneous complications are well documented 16 or antiplatelet drugs 6 remains the classical situation where DDH has been observed.…”

“…4,9,10,11,16 The signs of dermatoporosis and its complications, such as DDH, must also be early recognized by caregivers, carer, and patients affected by dermatoporosis, because the earlier the hematoma is removed, the less likely it is that the patient will sustain severe skin damage. 4,9 Although it has been reported under direct oral anticoagulants, the association of skin frailty and VKA-for which cutaneous complications are well documented 16 or antiplatelet drugs 6 remains the classical situation where DDH has been observed. 3,4,8 Hence, our report raises the issue of bleeding risk assessment in anticoagulated patients who may have dermatoporosis.…”