The conservative management of pretibial lacerations in elderly patients

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.

Section: Discussionsupporting

confidence: 86%

Management of pretibial lacerations: How patients' well-being is affected by their management

Vasdeki

Naji

Kelsey

et al. 2016

“…Pretibial wounds are a common problem and are often associated with prolonged healing when occurring in the elderly (Crawford and Gipson, 1977;Sutton and Pritty, 1985). Most pretibial injuries occur at home, with nearly 89% of the patients being female according to a recent series from Laing et al (2002).This difference in sexes (Laing et al, 2002) has been attributed to the greater longevity of females and also clothing fashion (women's legs being bare or inadequately covered).…”

Section: Introductionmentioning

confidence: 99%

Pretibial wounds: a review of current practice

Batchelor

Alagappan

2003

Pretibial wounds are often associated with prolonged wound healing, particularly in the elderly female population. The wounds characteristically have either a proximally or distally based flap. Delayed wound healing has been attributed to flap necrosis and poor blood supply to this area. The aim of this review article is to examine the vascular anatomy, pathology and management options of patients with pretibial wounds.

“…There has been discussion in the literature since the 1970s regarding conservative management versus excision and grafting of pretibial injuries. An average time quoted for healing of pretibial lacerations with conservative management alone is 65 days, with many patients requiring subsequent surgery (Crawford and Gipson, 1977). A review of 25 pretibial flap lacerations managed by either primary excision and split skin grafting or replacement of the defatted skin flap found faster healing in the grafted group (mean 13.2 vs. 40.7 days) (Haiart et al, 1990).…”

Section: Managementmentioning

confidence: 99%

The classification and principles of management of wounds in trauma

Barnard

Allison

2009

The correct assessment and early management of wounds is vital in achieving a good outcome in both the acute and chronic setting. A robust management plan for the trauma patient depends upon accurate and timely assessment of all injuries and evaluation of key features such as mechanism of injury, pre-hospital findings and intervention, zone of injury, patient characteristics and structures damaged. This article describes the general principles of wound assessment and management, discussing mechanism and zone of injury, debridement techniques, types of irrigation and the use of antibiotic prophylaxis. Particular attention is given to the management of open tibial fractures, fasciotomy wounds, pretibial lacerations and haematomas and bite wounds.