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"Conservative management of a bullous hematoma in the case of von Willebrand disease and hemophilia A."

Lundrim Marku, BS, MSc1 Mihail Climov MD2 Safak Uygur, MD2
West Virginia University school of medicine

Presenter: Lundrim Marku

To whom It may concern: This research has not been published elsewhere not presented at a major meeting. Kerri Woodberry, MD, MBA, FACS Kerri Woodberry, MD Kerri M. Woodberry, MD, MBA, FACS Division Chief Plastic and Reconstructive Surgery/ Hand Surgery Residency Program Director Associate Professor WVU Medicine One Medical Center Drive PO Box 9238 Morgantown, WV 26506-9238 Phone 304-293-3311 Fax 304-293-2556 kerri.woodberry@hsc.wvu.edu

Director Name: Kerri Woodberry, MD, MBA, FACS

Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction

A 67-year-old male with PMH of von Willebrand disease with low ristocetin: von Willebrand factor ratio and hemophilia A presented to WVUH three days post-trauma via motor vehicle accident. The patient's mechanism of injury involved bracing with their arm crossed and knees hitting the dashboard. After being evaluated via physical exam and radiographic images, the patient was found to have sustained a left anterior shin hematoma 15x 6 cm with a central bulla Figures 1&2. Follow-up clinic visit showed the hematoma was resolving well with a small central area of skin necrosis and continued to follow up in a month Figure 3. Discussion of the risks of draining the hematoma and the difficulty of controlling bleeding and expanding skin necrosis is critical to determining hematoma management and more so in a patient with vWD.
Surgical intervention of lower leg hematomas releases the tension created by closed hematomas. It prevents skin necrosis by creating a stab or laceration with a scalpel, followed by suction to evacuate the hematoma and irrigation with saline for a washout. The procedure is only performed when there is no additional risk of excessive bleeding, the reformation of hematoma, and skin necroses. The conservative management of lower leg hematomas primarily entails atraumatic debridement, followed by using hydrogels to allow for a proper wound bed for adequate soft tissue healing. However, using hydrogels with debridement can be tedious for the patient due to unroofing sensitive nerve endings and the potential risk of infection due to the moist area.

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