Deep Dissecting Hematoma, an Often Misdiagnosed Lesion: Case-Control Analysis of Risk Factors and Wound-Healing Prognosis

Abstract

Objectives

Deep dissecting hematomas (DDHs) represent severe acute wounds, predominantly affecting older patients. This study aimed to identify DDH risk factors and analyze factors associated with good wound-healing prognosis.

Design

Retrospective, multicenter, case-control study from January 2016 to March 2022.

Setting and Participants

A total of 240 patients, 60 patients with DDH and 180 controls with venous or arterial ulcers.

Methods

Primary endpoint was analysis of demographic and clinical parameter differences between patients and controls to identify DDH risk factors. Secondary endpoint was analysis of DDH-wound healing to identify factors associated with good prognosis defined as ≥40% healing of the initial wound 1 month after debridement.

Results

Patients were mainly female (n = 47, 78%), 63% misdiagnosed, median age: 87 years, and median Cumulative Illness Rating Scale (CIRS) score: 20/56. The low limb was the main DDH localization. Thirty-three (55%) patients had dermatoporosis, 53 (88%) were malnourished, and 51 (85%) had peripheral vascular disease. DDH developed post-trauma in 42 (70%) patients, with 29 (48%) of them resulting from falls. Half of the patients experienced DDH complications: acute anemia (n = 31, 52%) and local infection requiring oral antibiotics (n = 22, 37%). Time to starting appropriate care was significantly longer when the first DDH consultation was outside our expert center. DDH was significantly associated [adjusted OR (95% CI)] with low-molecular-weight heparin [1.95 (5.12–92.1); P < .001], dermatoporosis [3.75 (1.63–9.04); P = .002], age [1.09 (1.02–1.17); P = .02], and CIRS score [1.08 (1.01–1.17); P = .05]. Chemotherapy was significantly associated with delayed wound healing (P = .03) and age (P = .04) and skin grafting within 1 month (P = .003) were significantly associated with good wound healing.

Conclusions and Implications

This analysis of DDH risk factors based on a case-control study of a large geriatric cohort identified novel results on prognostic factors for DDH healing. Larger prospective studies are needed to extend our findings.