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I fell/tripped on some stairs on April 1, cracking my lower…

I fell/tripped on some...

I fell/tripped on some stairs on April 1, cracking my lower shin on the edge of a step. It immediately developed a very large hematoma about the size of a half dollar and raised up about 1/2 inch. The area around the hematoma was quite red. Also immediately the foot and lower leg became very swollen. We immediately applied ice and elevated the leg. The hematoma has decreased in size to about a quarter & developed a small leak. Applied gauze to absorb the leak. Removing the gauze bandage one day the tape stuck to some dry skin beside the hematoma and as I removed the bandage the top layer of the hematoma came off stuck to the gauze. It is now an open sore about the size of a nickle that continues to ooze fluid with very little blood in it, mostly a pinkish yellow color. The swelling in my foot as gone down somewhat, but still swollen, but the entire lower leg is still very swollen. I measured it against the other leg, and it is 3 inches further around. I have no fever or nausea and very little pain. But, I have neuropathy and consequently do not feel that much pain in my lower legs and feet. Since this happened on April 1 and it is now the end of the month, why has the swelling not gone down? And when can I expect this to be resolved? It seems to be taking a long time.

Doctor's Assistant: How long have you been dealing with this? Do you notice any redness or scaling?

I said above that it happened on April 1, so now it is 28 days. Yes there was and is redness above the bruise for about 4 inches and red around the bruise a few inches. Not really scaling, I don't think, but a lot of loose dead skin that keeps pealing away, some in fairly large pieces.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Besides the neuropathy, I have afib and am taking warfarin.

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Answered in 1 minute by:
4/27/2018
Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 10,550
Experience: MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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Hello, my name is***** and I shall be assisting you today. I'm reviewing your query & will get back to you shortly. Thank you for your patience.

Can you please attach a picture of the wound?

What is your age?

Let me know.

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Customer reply replied 3 months ago
I am 78 years old and do not know how to take or send a picture.

I can not comment much on the sore or lesion itself without the ability to see it. But since it has been more than 3 weeks that you have had this wound and it is discharging with a significant amount of swelling, it has most likely developed into a chronic non-healing ulcer. These ulcers are a problem and in your age group do not heal on their own. They require some form of debridement (surgical or chemical) and either dressings or skin grafting depending on the rate of healing. I will suggest that you seek a referral to a reconstructive plastic surgeon via your PCP for this. The vascularity of your lower limbs needs to be assessed with a doppler ultrasound and a swab from the wound needs to be sent to the lab to rule out infection. From there it is all wound management and a plastic surgeon will be the best person for that.

I sincerely ***** ***** I have helped you and that I have earned my 5-star rating today! Please remember to rate my service by selecting the 5-stars at the top of the screen (rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!

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Customer reply replied 3 months ago
Can I keep this open for a while? My granddaughter will be here shortly for a visit and I'm sure she knows how to take and send you a picture. I definitely will give you a 5 star rating, but would like to be able to show you the wound. You didn't mention the swelling of the entire lower leg. What causes that and what can be done about the swelling?

The leg swelling is due to fluid retention or edema, that can be a consequence of the trauma or vascular insufficiency or both. There are possibly more than one factors at play here. The impeding vascularity of the limb that is causing the delayed healing and the edema, the wound that might be causing the edema, the wound being infected causing the edema etc.

Yes, you can always come back and reply here on this thread. You can also leave a positive rating and this thread will still be open for you in case you want to reply back and ask any follow up questions.

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Customer reply replied 3 months ago
Sending Photos
Customer reply replied 3 months ago
Here are the photos. One is just to show you how the one leg is more swollen than the other. The rest are just of the wound which is about the size of a quarter now.
Thank you.
This is a chronic non healing ulcer. The skin changes around it are known as lipodermatosclerosis which are a characteristic sign of venous insufficiency. You need to see a plastic surgeon and also get a Doppler ultrasound done. Your PCP can guide you further.
Hope this helps.
Please do leave a positive rating for the service.
Best wishes.
Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 10,550
Experience: MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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