A 74-year-old man presented with extensive pretibial skin necrosis following a neglected post-traumatic hematoma. Progressive tissue necrosis led to a large full-thickness soft-tissue defect over the anterior tibia, creating a challenging wound with a high risk of infection and prolonged healing.

Radical surgical debridement was performed, completely excising all necrotic skin and devitalized subcutaneous tissue until healthy, bleeding tissue was reached. The wound was managed with meticulous local wound care, allowing progressive granulation tissue formation and healing by secondary intention.

The wound healed progressively over approximately 3 months, achieving stable soft-tissue coverage without the need for skin grafting or flap reconstruction.

This case demonstrates that even extensive pretibial necrosis following a neglected hematoma can heal successfully through meticulous surgical debridement and structured wound care, avoiding more complex reconstructive procedures.