A skin blister may form following significant local tissue trauma with a closed fracture of underlying bone.
A skin blister occurs at sites with limited tissue coverage (knees, ankle, foot), typically in association with high-energy trauma and underlying tissue edema. It tends to occur 6 to 72 hours after the trauma.
The blister may be filled either with clear serous fluid or with hemorrhagic fluid.
The diagnosis requires exclusion of another cause such as second degree burn or diabetes.
If blisters develop or are anticipated, then external fixation should be done initially to prevent further soft tissue damage, with definitive fracture fixation to follow when appropriate.
Blisters should be left intact and covered with soft tissue dressings.
Skin incisions for definitive management should avoid areas with hemorrhagic blisters. Incisions in these areas show a greater risk of postoperative soft tissue complications.
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