The UK has the best demographic data on the subject. There are 5.2 pretibial lacerations per 1000 emergency visits in the UK (2). In 2018-19, there were 67,000 emergency visits per day in the UK (3). This means the number of injuries per year is 348/day x 365=127,166 such injuries annually. There are 66 million people in the UK, for an annual incidence of 0.2%. If we translate this to the USA (population 325 million) we are considering about 800,000 such injuries annually.
These injuries happen most often with a minor collision or fall, but severe lacerations can result. There is a classification by Dunkin that grades these injuries I-IV, with over 50% falling in the more severe grades, with significant skin damage/loss (4). In this series 2/3 of patients required admission. Healing times are lengthy, on the order of 60 days for those managed with skin grafts, and 120 days for those managed with wound care alone (5).
IN the UK, admission cost is approximately $4500, but costs in the US are much higher (average cost of admission $10,700 per Healthcare Cost and Utilization Project (HCUP). If 2/3 are admitted as in Singh’s series, the cost in the USA might be 500,000 x $10K or $5B.
How can we help? This type of skin is damaged easily and is typically not able to be sutured due to suture tearing through the thin skin. Some skin is frankly necrotic if presenting late to care. But if the skin can be fully removed early on, cleaned and placed as an immediate skin graft, this method can be successful (6). If the skin is present and viable but just lacerated, HEMIGARD can facilitate suture repair as it prevents suture tearing through the skin. Repairs with adhesive tape only are limited as drainage typically lifts the adhesive tape off in days. HEMIGARD should be able to persist and adhere for 10-14 days during which time healing can be well underway. And the gentle adhesive allows atraumatic removal. We feel the HEMIGARDTM Retention Suture device can be a useful tool to assist in the management of this difficult problem.