Therapeutic management of traumatic tension hematoma with potential skin necrosis: a retrospective review of 180 patients

Autores de IIS La Fe

• Elena García Vilariño

  Autor

• Alberto Pérez García

  Autor

Participantes ajenos a IIS La Fe

• Salmerón-González E

Grupos

• Dermatología y Regeneración Tisular

  

  Leader

  Rafael Botella Estrada

Abstract

Introduction Tension hematoma is a frequent traumatic condition in elderly population under anticoagulation treatments. However, scarce literature exists focused in the management of this condition. In this article, a retrospective study of patients that suffered from traumatic tension hematomas treated at a plastic surgery department is reported. The objective was to evaluate the approach that provided better clinical outcomes, and the establishment of an evidence-based protocol. Methods This retrospective study comprised 180 patients suffering from tension hematomas. Patients were divided in four groups: the first and second groups included patients that underwent debridement and coverage in one stage and two stages, respectively. The third group included patients that required debridement without skin grafting, and the fourth group, patients with hematomas that only necessitated drainage. Demographic variables, comorbidities, timing and complication rates of each technique were evaluated. Results Length of hospital stay, medical complication and mortality rates were significantly higher in patients who underwent debridement and coverage surgeries in two separate procedures (p < 0.05). Patients with small-sized hematomas (avg 0.63% of total body surface) required only debridement. Patients that only required hematoma drainage, were treated during the first 24 h after injury (p < 0.03). Conclusions Treatment of tension hematomas through early drainage should be performed as soon as possible from the time of injury. An evidence-based protocol should be established in every emergency department to improve patient clinical outcomes. When debridement and coverage surgery are required, they should be performed in one stage, to reduce length of hospital stay and the incidence of medical complications.

© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords

• Subcutaneous hematoma; Tension hematoma; Haematoma; Skin graft; Necrosis; Drainage; Debridement