Extensive Bullous Complication Associated with Intermittent Pneumatic Compression
An 81-year-old woman, who sustained an intertrochanteric fracture on her left hip, was admitted via emergency room. She had been medicated with a beta-blocker for the treatment of hypertension. Otherwise, she did not take any medicine including steroids or anti-platelet drugs. She had no history of skin allergies, and preoperative laboratory examination revealed no evidence of coagulopathy. She underwent a cementless bipolar hemiarthroplasty under a spinal anesthesia. No special event occurred during the operation.\nPostoperatively, IPC device (Kendall SCD EXPRESS™; Covidien, Mansfield, MA, USA) was applied on her both legs. According to a manufacture's brochure, the sleeve is made of a soft, lightweight, non-woven material, which can promote patient's comfort and compliance, and the microprocessor controls a 11-second-compression cycle to ensure 45 mm Hg-pressure delivery at the ankle, with resulting pressures of 40 mm Hg and 30 mm Hg sequentially at the calf and thigh.\nThere were no special events during hip fracture surgery, and her vital signs were stable on immediate postoperative period. But the patient became delirious on postoperative day 1. On the postoperative day 3, when she recovered from the delirium, she complained of left leg pain, and extensive large bullous skin lesions were found in her left leg. The lesions developed circumferentially beneath the IPC sleeves (). On physical examination, distal pulses, sensation and motor function were intact.\nImmediately after the detection of skin lesions, IPC device was removed. The patient was consulted to a dermatologist and a diagnosis of fragile skin was made. Hemorrhagic fluid was aspirated, and wet dressing was applied. After 7 days, the skin lesions improved and the hemorrhagic bullae disappeared.