Pretibial injuries : Clinical presentation, treatment paths, and health economic burden

Pretibial injuries are universal traumas among the morbid and elderly population. The injuries present as two distinct clinical variations: pretibial lacerations (PLs) and pretibial hematomas (PHs). PLs and PHs affect the skin and subcutaneous tissue between the knee joint and ankle due to low-energy trauma such as falling on flat ground. PLs constitute different types of open wounds e.g. linear lacerations, flap lacerations, and total skin loss. PHs form when closed subcutaneous bleeding occurs. Blood causes soft tissue bulging and pressure to the skin, which can lead to skin necrosis if the hematoma is not evacuated. Both injuries result in skin defects needing local wound care and/or a split-thickness skin graft (STSG). The study was a retrospective analysis of electronic patient history files. Patients were diagnosed at Kymenlaakso Central Hospital and its surrounding healthcare centers during 2015-2019. Study I included 116 PL patients and Study II 60 PH patients. In Study II, risk factors for skin necrosis were identified by comparing patients treated with PH evacuation with those treated without intervention. Study III included 12 pretibial injury patients treated with STSG. In Study IV, a calculation and comparison of costs of 109 PL and 60 PH patients were conducted by examining NordDRG products and their invoice data generated from patient treatment periods. Pretibial injuries have characteristic features that must be recognized when diagnosing and treating patients. Skin defects caused by PLs and PHs frequently result in chronic wounds. Thus, pretibial injuries should be considered an independent etiological pathology for chronic leg ulcers. PHs among morbid dermatoporotic patients require prompt surgical intervention to ease pain and prevent skin necrosis. However, PHs seem to not be recognized in time. Further, the infection rate of 30% among PLs and long treatment periods also suggest failures in current treatment. Only 15 patients of all pretibial injury patients were treated with STSG. Using STSG was safe and did not result in significant complications, although prolonged donor site healing did occur. Thus, early STSG application should not be avoided. Compared with PLs, PHs generate higher costs in healthcare mainly from emergency room visits and operative treatment. PLs cause more burden in the outpatient wound clinic. Improved diagnosis and treatment are critical to cut costs and reduce patient suffering.

Grantor dc:publisher

Helsingin yliopisto

Year dc:date.issued

2023

Author dc:creator

• Seppälä, Toni

• plastiikkakirurgia

Statement dc:rights

• Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
• This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.
• Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden.

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/10138/356394

OAI record oai:identifier

https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F356394