Stepwise Surgical Technique Used to Treat Recalcitrant Pretibial Ulcerations: A Case Series

Abstract

Introduction. Pretibial lacerations resulting from trauma may evolve into chronic wounds with worsening infections without treatment. There is a limited amount of literature on the presentation and treatment of recalcitrant pretibial ulcerations. Objective. This study aims to provide a review of surgical treatment methodology that successfully managed recalcitrant pretibial ulcerations. Materials and Methods. The authors conducted a retrospective case review of patients with pretibial ulcerations. All wounds underwent aggressive debridement in the operative setting. Next, the wounds were fenestrated with a needle before placing one application of an antimicrobial acellular dermal tissue matrix derived from fetal bovine dermis, which was tightly adhered onto the wound bed. All wounds received a uniform multilayer compression dressing. Results. Three patients with pretibial ulcerations were included in this study. Each wound was a result of mechanical trauma and deteriorated into a refractory ulceration despite initial conservative treatment for more than 6 months. All ulcers exhibited local infection of cellulitis, hematoma, and a collection of purulent fluid. None of the wounds had any signs of radiographic osteomyelitis. The application of the allograft following debridement and fenestration led to wound volume reduction by 75%, 66.7%, and 50% in 3 patients in 28 days. All wounds healed successfully within 4 months. Conclusions. The combination of a fenestration method and an antimicrobial fetal bovine dermal matrix successfully healed recalcitrant pretibial ulcerations in high-risk patients.