More Than Meets The Eye With Bumps and Bruises on the Shins

The damage that is done to the layers under the skin can be just as dangerous as a skin tear on the skin. A bump to the shin causes bleeding that may lead to a hematoma or large accumulation of blood that forms a mass under the skin. A hematoma is a collection of blood under the skin that occurs as a result of the separation of the skin and the layer under the skin from the muscle tissue called fascia. Blood vessels, muscles, and nerves are often injured as well.  Pressure from an injury may cause compartment syndrome that could cause nerve damage. People on blood thinners will have more bleeding than those who are not taking blood thinners. Adults are at risk for bumping the lower legs that may result in a hematoma under the skin.  As we age the skin is less elastic, with less amount of that layer under the skin called subcutaneous tissue.  The space then fills with blood that may cause enough pressure to cause the cells to die (called necrosis).  Even a minor bump may cause a big problem.  This mass of blood under the skin often may become infected.  The hematoma may need to be evacuated by a surgeon. If the hematoma is not managed correctly it often extends to a full thickness skin loss that may require a skin graft or a prolonged healing process that starts from the inside out.  Early evacuation of the hematoma may prevent weeks of costly treatments and grafts.  Other factors like balance, disease of the veins and arteries, and disease that effects the nerves called neuropathy contribute to the risk of already aging skin. Medications may also reduce the ability for skin to heal. The best way to manage a wound is to prevent it in the first place. Amen to that.

Don't Feel Bad

As a Nurse Practitioner I focus my care on prevention of problems and complications.  One way to help protect our lower legs is to wear ShinGrins.  Think of that old saying "an ounce of prevention is worth a pound of cure".  Lower leg wounds could take many weeks to heal, become infected, painful,  and cost much time and money.  Wear ShinGrins with confidence and be smart about protection and prevention.  Life is to short and time is to precious to be spending it at the wound care clinics! So feel great about wearing the ShinGrins and don't feel bad.  

Handle With Care

Aging skin requires a gentle touch.  Caregivers, helpers, spouses and even our own nails can easily tear the skin.  Any quick movement or rough handling can cause a skin tear.  Wearing long sleeves may help protect the arms and ShinGrins may help protect the lower legs.  People who are ambulating are particularly prone to skin tears in the lower extremities.  Simple daily routine activities can turn into a painful and frustrating event. Handle with care and prevent painful wounds.

Age and Skin Changes

    Skin may seem transparent, pale and thin with age. Deposits of pigmented patches, freckles, and hypo pigmented patches give the appearance of irregularity.  The skin becomes drier, and flaky over the extremities and loses the elasticity of youth.  The skin is thinner over bony prominences and more prone to injury. Aging has a direct influence on the ability for a wound to heal.  The increased frequency of skin trauma in the aging population relate to function and structure of aging skin, balance, medications, immune system, and other medical problems.  The aging population requires education and prevention of illness and traumatic injuries including skin wounds.  ShinGrins may help protect the lower extremities from bruises, bumps and wounds. 

Skin Tears

Skin tears in the lower extremities are common.  The increased cost of wound care, healthcare provider visits, dressing changes, creams and fillers, and medicines far outweigh the cost of prevention.  The pain of a wound in the lower extremity is both physical and emotional.  My own study demonstrated a need to prevent lower extremity wounds particularly in people with diabetes, impaired gait, and on blood thinners and prednisone.  There are many conditions associated with increased risk for lower extremity wounds and extended healing time including age, BMI, nutritional intake, medication, activity activity level and chronic illness.  Lower extremity wounds could take a month to heal or longer.  Often there will be another injury and the cycle of pain and wound care starts all over again.

Non Healing Wounds

Wounds that become chronic may require specialized wound care management.  A wound that does not heal after 8 weeks has become chronic. See your healthcare provider immediately after sustaining a lower extremity injury to start appropriate treatment immediately.  Prevention of wounds in the lower legs is the best way to manage a wound.  

Medications That Inhibit Wound Healing

Common medications that impair wound healing include and not limited to:   Prednisone, Furosemide, Spironolactone, Captopril, Levodopa-carpodopa, Metformin, Tamoxifen, Methotrexate, NSAIDS, and Testosterone.    People taking medications that may impair wound healing need to be extra careful to protect the skin.  

Non Healing Wounds

People taking blood thinners, steroids, or those with peripheral vascular disease, circulation problems, impaired gait or just plain clumsy, may sustain an injury to the lower extremity that may never heal due to repeated trauma in the same area.  Other factors that may contribute to non healing of a wound include infection, lack of circulation to the wound from a blood clot or other circulation problems, dead tissue in the wound bed, and skin cancers. The wound that does not heal is in a state of chronic inflammation that contributes to the inability to heal. Protecting the lower leg may help to reduce the trauma to this sensitive and delicate area.