← Debridement and Drainage Clinical Cases

Post-Traumatic Pretibial Necrosis Following Neglected Hematoma

Clinical presentation, surgical treatment and documented healing.

01 / Problem: Clinical presentation
02 / Procedure: Surgical approach
03 / Outcome: Healing & follow-up

Clinical photographs below include wounds and surgical treatment.

01 / CLINICAL PRESENTATION

Problem

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.

Post-Traumatic Pretibial Necrosis Following Neglected Hematoma before image — Problem

02 / SURGICAL APPROACH

Procedure

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.

03 / HEALING & FOLLOW-UP

Outcome

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.