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Treatment of Pretibial (Leg) Haematomas & Lacerations

Pretibial haematomas and lacerations are very common injuries particularly in elderly people with very thin skin. The injury usually occurs after relatively minor trauma to the shin area of the leg. Because the skin is thin and there is very little subcutaneous padding between the skin and the underlying bone, it is easy to injure the tissue.

If there is a flap laceration and the skin is not too damaged, it can simply be put back in place after cleaning the wound and held with steristrips or sutures. If skin is too damaged to be put back in place or there is an underlying haematoma (collection of blood from bleeding under the skin) putting pressure on the skin, it may be necessary to debride or clean away the damaged skin and haematoma. Usually a skin graft is needed to heal the wound in this situation unless the area involved is small. The skin graft (split thickness) is a shaving of skin, often from the thigh on the same leg, which is used to replace the lost skin of the leg. Because it is only the top layer of skin that is used as a graft, where it is taken from (donor site) can heal over the next two weeks or so from the remaining skin left behind. The skin graft takes 4 to 5 days to adhere to the leg wound and may require dressings for a week or so afterwards.

This procedure can be done under local or general anaesthetic depending on the size of the wound involved. Sometimes you will be advised to rest in bed afterwards, but I advise most people to remain mobile. Walking short distances frequently and elevating your leg on a foot rest or sofa when not walking is better for your health than remaining in bed for the full 5 days.