University Hospital Dr Peset, Avenida de Fernando Abril Martorell, nº 106, Torre E, Planta 5, 46023, Valencia, Comunidad Valenciana, Spain.
University and Polytechnic Hospital La Fe, Valencia, Spain.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1363-1367. doi: 10.1007/s00068-021-01687-z. Epub 2021 May 20.
Tension hematoma is a frequent traumatic condition in elderly population under anticoagulation treatments. However, scarce literature exists focused in the management of this condition. In this article, a retrospective study of patients that suffered from traumatic tension hematomas treated at a plastic surgery department is reported. The objective was to evaluate the approach that provided better clinical outcomes, and the establishment of an evidence-based protocol.
This retrospective study comprised 180 patients suffering from tension hematomas. Patients were divided in four groups: the first and second groups included patients that underwent debridement and coverage in one stage and two stages, respectively. The third group included patients that required debridement without skin grafting, and the fourth group, patients with hematomas that only necessitated drainage. Demographic variables, comorbidities, timing and complication rates of each technique were evaluated.
Length of hospital stay, medical complication and mortality rates were significantly higher in patients who underwent debridement and coverage surgeries in two separate procedures (p < 0.05). Patients with small-sized hematomas (avg 0.63% of total body surface) required only debridement. Patients that only required hematoma drainage, were treated during the first 24 h after injury (p < 0.03).
Treatment of tension hematomas through early drainage should be performed as soon as possible from the time of injury. An evidence-based protocol should be established in every emergency department to improve patient clinical outcomes. When debridement and coverage surgery are required, they should be performed in one stage, to reduce length of hospital stay and the incidence of medical complications.
在接受抗凝治疗的老年人群中，张力性血肿是一种常见的外伤性疾病。然而，目前针对这种情况的治疗方法的文献相对较少。本文报道了在一家整形科治疗外伤性张力性血肿患者的回顾性研究。目的是评估哪种治疗方法能提供更好的临床效果，并建立一个基于证据的方案。
本回顾性研究纳入了 180 名患有张力性血肿的患者。患者分为四组：第一组和第二组分别接受了一期和二期清创加覆盖术；第三组包括需要清创但不需要植皮的患者；第四组为仅需引流的血肿患者。评估了每组患者的人口统计学变量、合并症、每种技术的时机和并发症发生率。
分两期进行清创加覆盖术的患者的住院时间、医疗并发症和死亡率明显更高（p<0.05）。小面积血肿（平均占体表面积的 0.63%）患者仅需清创术治疗。仅需血肿引流的患者在受伤后 24 小时内接受治疗（p<0.03）。
张力性血肿应尽早进行引流治疗，从受伤时开始。每个急诊科都应建立一个基于证据的方案，以改善患者的临床结果。当需要清创和覆盖手术时，应一期完成，以减少住院时间和医疗并发症的发生率。
