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Review
. 2020 Jun;17(3):540-546.
doi: 10.1111/iwj.13312. Epub 2020 Jan 23.

Multiple subcutaneous haematomas of the legs causing skin necrosis in an elderly patient affected by corticosteroid-induced skin atrophy: Case report and review of literature

Valerio Vallini  1 , Elisabetta Rinaldi  1 , Luciana Mangano  1 , Luca Modesti  2 , Piero Ghelardini  1 , Anna Theresa Roberts  1 , Giovanni Grazi  1
Affiliations
Review

Multiple subcutaneous haematomas of the legs causing skin necrosis in an elderly patient affected by corticosteroid-induced skin atrophy: Case report and review of literature

Valerio Vallini et al. Int Wound J. 2020 Jun.

Abstract

Corticosteroid-induced skin atrophy (CISA) consists of a thinning of the skin and subcutaneous tissues, representing the natural consequence of a prolonged glucocorticosteroids use, both systemic as well as topical. It is characterised by the loss of elasticity and skin thickness, associated with an increased skin fragility leading to ecchymoses, haematomas, and steroid purpura. The management of CISA is a challenge for physicians, as the pathology is reversible in a minimal percentage of cases and only after a short topical steroid or low-dose course therapy. Often wounds with large loss of substance represent the more common complication, after a surgical drainage which is often necessary. Skin necrosis with compartment syndrome of a leg is another potential risk for these patients. Here, we report a case of an elderly patient affected by multiple subcutaneous haematomas of the legs causing skin necrosis, arisen after the use of anticoagulants for a deep venous thrombosis. The patient was successfully treated with surgical drainage, negative pressure wound therapy (NPWT), and porcine xenograft with no complications. Finally, we discuss the evidence of the current literature on topic.

Keywords: compartment syndrome; corticosteroid-induced skin atrophy; porcine xenograft; skin necrosis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Hematoma of left leg surgically drained and consequent wound healed with NPWT in 52 days
Figure 2
Figure 2
Calf necrosis as a consequence of compartment syndrome
Figure 3
Figure 3
Porcine xenograft fixed on the atrophic periwound with surgical tape strips
Figure 4
Figure 4
Hydrogel‐impregnated dressing coated with a hydrophobic fatty acid applied on the porcine xenograft
Figure 5
Figure 5
Wound incorporation of porcine xenograft after 7 days
Figure 6
Figure 6
Wound appearance after 28 days from the xenograft application
See this image and copyright information in PMC

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