Management of pretibial lacerations: How patients' well-being is affected by their management

Abstract

Background Pretibial lacerations remain one of the commonest problems in plastic surgery. There is still no evidence of superiority of either a conservative or surgical approach for their management, nor any documentation regarding patients' performance following each approach. Methods We conducted a retrospective study of all patients treated for pretibial lacerations/haematomas in our unit, from May 2013 till April 2014 who were offered surgical or conservative management. Conservative management included washout of wound and application of non-adhesive dressings; the patients were discharged home on the same day and followed up in dressing clinic. The Eastern Cooperative Oncology Group score was used to assess patients' well-being during healing time. Results There were 38 patients; 21 opted for conservative management and 17 for skin grafting, after consultation. Overall, 66% of conservatively managed wounds were completely healed and patients were discharged. Mean healing time was 66.28 (13–172) days and required 3.43 (1–8) visits to the unit. In the surgically managed group, 88% of the patients had their wounds completely healed with a mean healing time of 69.5 (14–147) days and 5.87 (2–11) visits to the unit required. Of the conservatively managed patients, 55.6% scored 0 on the Eastern Cooperative Oncology Group scale, denoting fine health, while only 7.6% of the surgically managed patients scored zero. In total, 77.8% of the conservatively managed patients reported they would not have a chosen a skin graft if given the choice again. Conclusion This study shows that satisfactory healing of pretibial lacerations may be achieved without surgical intervention in a high-risk group of patients, who reported good overall performance during healing time.