# Deep Dissecting Hematoma Requiring Surgical Removal During Veno-Venous Extracorporeal Membrane Oxygenation Management: A Case Report

## TL;DR

A 58-year-old man with severe COVID-19 developed a deep dissecting hematoma requiring surgery while on VV-ECMO, highlighting the importance of early diagnosis and treatment.

## Contribution

This case report highlights the diagnostic and treatment approach for DDH in a critically ill patient on VV-ECMO.

## Key findings

- DDH was diagnosed and treated with surgical removal and skin grafting in a patient on VV-ECMO.
- Exploratory incision is crucial for diagnosing DDH and preventing skin necrosis.
- DDH symptoms include erythema, swelling, and pain, requiring differentiation from soft tissue infections.

## Abstract

Deep dissecting hematoma (DDH) is a disease in which minor trauma leads to the formation of an extensive hematoma. If left untreated, this can result in significant skin necrosis. Therefore, early treatment following a precise diagnosis is essential. However, the complexity of the disease may require differentiating it from soft tissue infections. A 58-year-old man with severe coronavirus disease 2019 (COVID-19) pneumonia developed skin complications such as purpura and blisters on his right upper extremity while undergoing veno-venous extracorporeal membrane oxygenation (VV-ECMO). We initially suspected a soft tissue infection or venous perfusion defect caused by the VV-ECMO cannula; however, these conditions were not observed. After making an exploratory incision, we diagnosed the patient with DDH and performed hematoma removal and skin grafting. The initial symptoms of DDH include erythema, swelling, and pain. It is important to differentiate DDH from soft tissue infections, especially necrotizing fasciitis, which is a more urgent condition. Because a surgical incision is necessary for the diagnosis and treatment of DDH, we do not hesitate to perform an exploratory incision to prevent skin necrosis, thereby contributing to early healing.