Help for Hematomas: Effective Treatment of Complex Wounds in an Outpatient Setting

Background: A collection of coagulated blood within the tissue space, hematomas usually occur after a traumatic injury. When they occur in the lower extremities and a complex chronic wound ensues, an effective treatment plan must be comprehensive and effective. Factors such as traumatic injury combined with anticoagulant therapy, advanced age and venous insufficiency compound the situation. The goal for wound treatment is to heal as effectively as possible without complications such as the need for surgical intervention and serious infection.

Method: Three different patients in our outpatient wound care center presented with wounds caused by a hematoma. Because the wounds were in the lower extremities, edema with venous hypertension was also present. Negative pressure wound therapy, which has been shown to decrease bioburden, decrease edema and increase granulation tissue was utilized. Two of the patients were offered bilayered live skin substitutes to promote cellular migration and wound closure while one was offered a dermal collagen template; the addition of these skin substitutes in the wound care setting helps wounds heal in a third of the standard time. Lastly, compression allowed for further decrease of vein distention and edema. Most significant was that none of the patients required hospitalization and/or surgical intervention with anesthesia, which can be risky due to comorbidities and advanced age of greater than 65.

Conclusion: Aggressive treatment in an advanced wound care center for traumatic leg injuries with hematomas can result in healing in 30 weeks or less. The use of negative pressure therapy, compression and bilayered live allografts or advanced collagens helped to heal these wounds safely and effectively. What began as potentially catastrophic hematomas gradually became more manageable leg ulcers and, finally, completely healed skin.