Figure Legend: Tense dorsal hand hematomas may result in necrosis of the overlying skin.  This problem occurs most often in the context of anticoagulation.  Emergent surgical evacuation may limit the extent of soft tissue loss, but the extent of the problem may be impossible to determine in the acutely ill and unstable patient.  Skin graft or flap coverage is usually required, and hand stiffness is a common outcome.
 

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