Occurrence and the Need for Inpatient Treatment of Full-Thickness, Lower-Extremity Soft Tissue Necrosis Caused By Traumatic Hematomas in Anticoagulated Patients

Disorders such as chronic heart diseases, venous thromboembolism, peripheral vascular disease, and recurrent transient ischemic attacks often require treatment with anticoagulation therapy. Unfortunately, hemorrhagic complications of anticoagulant therapy are frequent and debilitating. Low impact blunt trauma to the lower extremities sustained by patients treated with anticoagulation therapy might result in the development of substantial subcutaneous tissue hematomas. As the hematoma expands, pressure within may exceed the perfusion pressure of the dermal and subdermal capillaries leading to devascularization of the overlying skin and adjacent subcutaneous tissue , this can result in full-thickness necrosis of the skin and subcutaneous tissue leading to the development of very complex wounds that is difficult to manage, particularly in a debilitated elderly patient with multiple medical comorbidities. We would like to present 6 cases of elderly patients who suffered this kind of wound due to different kind of anticoagulants and our treatment methods.

Methods: Retrospective review of patient`s charts and electronic data. Six elderly patients (79.6 ± 7.3 years) presented with large, full-thickness, necrotic, lower extremity wounds. The wounds developed at the site of blunt trauma, which occurred (15 ± 15 days) prior to presentation and caused expansive hematomas while on therapeutic anticoagulation therapy with ELIQUIES, COUMADIN ,XARELTO , ASPIRIN .All the patients had high c-reactive protein levels . They had debridement and irrigation in the operating room and vacuum assisted closure (VAC) applied after surgery .They were hospitalized for (12 ± 8 days), and released with VAC for outpatient treatment and observation .

Results: All wounds completely epithelialized (100% closure) by an average of 8 ± 2 weeks from initiation of therapy.

Conclusion: Patients with large, full-thickness, necrotic, lower extremity wounds caused by traumatic hematomas while on anticoagulation therapy can be appropriately managed withought the need of skin grafts and long hospitalizations.