Implementation of the Dedicated Lower Extremity Hematoma Algorithm (LEHA) Will Improve Trauma Patient Outcomes

Background:
As our population ages there are an increased number of patients at risk for trauma or falls. These patients often have multiple comorbidities such as diabetes or peripheral vascular disease (PVD) that can contribute to thinning of the skin in the lower extremity.  The use of aspirin, warfarin and Novel Oral Anticoagulants is also increasingly common in this subset of patients. Among the potential sequelae of such events is soft-tissue injury. These patients are frequently seen in out-patient wound centers with complications such as infection, skin loss, need for surgical intervention and chronic non-healing wounds, having developed subcutaneous hematomas after mismanagement of their initial injuries. 
 
Objective:
To develop an easy to follow algorithm for appropriate treatment protocols to prevent, diagnose and treat lower extremity hematomas.  Such algorithm will aid in timely and appropriate wound care referrals, resulting in better patient outcomes.

Methods:
A literature search was conducted in PubMed of key words: pretibial, soft-tissue injury, lower extremities, lower extremity, leg, lower leg injuries, hematoma, & degloving from 2011 through the present. No randomized controlled trials or cohort studies were found specifically relating to lower extremity hematomas. One systematic review of pre-tibial lacerations from a trauma center and one retrospective study on the cost of pre-tibial hematoma management in 62 patients were found.

Conclusions:
Using the information obtained from the articles found in the literature review along with the authors’ clinical experience, the easy to use LEHA was constructed to aid the prevention, diagnosis and treatment of lower extremity hematomas. It is the authors’ opinion that implementation of this evidence-based approach will decrease the potential for chronic non-healing wounds post traumatic wounds of the lower extremity. 

Trademarked Items (if applicable):

References (if applicable): References:

Lo, S., Hallam, M. J., Smith, S., & Cubison, T. (2011, December 24). The tertiary management of pretrial lacerations. Journal of Plastic, Reconstructive, and Aesthetic Surgery, 65(9), 1143-1150. doi:10.1016/j.bjps.2011.12.036

Tuboku-Metzger, V., Chamber, J., Osmani, O., Nightingale, P., Eltigani, T., & Skillman, J. M. (2014, May). Early debridement reduces time to healing in elderly patients with pretrial injury. Journal of plastic, reconstructive, and aesthetic surgeons, 67(5), 742-744. doi:10.1016/j.bjps.2013.12.013

Karthikeyan, G., Vadodaria, S., & Stanley, P. (2003, April). Simple and safe treatment of pretibial hematoma in elderly patients. Emergency Medicine Journal, 21(1), 69-70.

Hill, S., Wong, K., & Stephens, P. (2017, November). Pretibial Lacerations. British Journal of Hospital Medicine, 78(11), 162-166.

Pagen, M., & Hunter, J. (2011, March). Lower leg hematoma: Potential for complications in older people. Wound Practice and Research, 19(1), 21-28.