Pretibial lacerations: experience from a lower limb trauma centre and systematic review.
BACKGROUND
Pretibial lacerations are an important and neglected problem among the elderly. Poor management leads to prolonged hospitalisation and terminal decline. This study summarises our experience and evidence from the literature to ascertain an evidence-based rationale for referral and management.


METHODS
Our data were obtained from review of a prospectively gathered database. Additionally, Pubmed, Embase, Medline, and the Cochrane Database of Systematic Reviews were searched through July 2013, with eligible studies evaluated using standard methodology.


RESULTS
Seventy-three pretibial lacerations in 73 patients (63 females) were identified. Mean age was 78 ± 14, 1SD. Sixty patients were managed operatively with a mean length of stay of 11 ± 7 days, 1SD when uncomplicated by medical co-morbidity. Seven deaths occurred (4 in-hospital; 2 treated surgically and 2 treated conservatively) and 3 deaths occurred within 3 months of discharge; a death rate more than twice that of matched controls. Donor site "over-grafting" was performed in 19 cases and resulted in accelerated donor site healing (11 ± 9 days, 1SD vs. 29 ± 42 days, 1SD; P < 0.001). Negative pressure wound therapy delayed discharge (21 ± 23 days, 1SD vs. 15 ± 14 days, 1SD; P = 0.028). Microbiological sampling is unhelpful. Bed rest is unnecessary. "De-fatting" the flap is unproven.


CONCLUSION
Admissions expose the elderly to physical/functional decline and death. Our findings support a change of practice, minimising admissions for minor (Dunkin type I/II) injuries and rapid, protocol-driven surgical intervention and discharge for Dunkin type III/IV injuries with avoidance of negative pressure wound therapy in all but selected cases.
['Glass|G E|GE|', 'Jain|A|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001458:Bandages D002481:Cellulitis D003646:Debridement D005260:Female D006406:Hematoma D017052:Hospital Mortality D006801:Humans D022125:Lacerations D007869:Leg Injuries D007902:Length of Stay D008297:Male D008875:Middle Aged D012189:Retrospective Studies D016038:Skin Transplantation D061665:Time-to-Treatment D014945:Wound Healing
Pretibial laceration Elderly Management Dunkin classification Haematoma