Drainage of hematoma and other methods of its treatment
The human body is riddled with blood vessels.
During domestic, industrial or sports injuries, the integrity of the wall of a particular vessel is compromised. This can lead to bleeding or hematoma formation. Hematoma is an accumulation of liquid or coagulated blood in the thickness of soft tissue. This is often a harmless phenomenon, but in some cases doctors are often faced with the need to remove a large hematoma, which can interfere with the functioning of tissues and neighboring organs. Hematomas can form:
- for all types of injuries – closed and open;
- in any part of the human body;
- for injuries of any degree - from minor (in this case, the role is played not by physical effort, but by the fragility of the vascular wall) to severe.
Hematomas can occur not only when physical force is applied to the tissues, but also several hours and days after that. An example is an internal hematoma after surgery - when sutures placed on blood vessels damaged during surgery fail. The possibility of such tissue hemorrhages must be constantly remembered. The timeliness of diagnosis, and therefore the success of hematoma treatment, depends on this.
Three degrees of injury:
According to statistics, 44% of all injuries are bruises, many of which require qualified assistance from a surgeon. Based on the severity of damage to tissues and joints during bruises, there are three degrees:
- Mild bruises - the functions of the bruised organ are not impaired, are accompanied by mild local pain and a late-occurring subcutaneous hematoma (12-21 hours after the injury). If there are no complications, then such bruises end with complete recovery and restoration of function.
- Moderate bruises - partial dysfunction of the organ, clear local pain, swelling at the site of the bruise, extensive hematoma, detected 3-5 hours after the injury. With a moderate injury to a joint, hemarthrosis (bleeding into the joint) is usually detected. Moderate bruises require an in-person examination by a surgeon, application of a pressure bandage, and, if necessary, removal of blood from the hematoma or affected joint.
- Severe bruises with partial or complete impairment of function due to severe pain or damage, with diffuse swelling and pain at the site of the bruise, rapidly increasing subcutaneous hematoma (1-2 hours after injury); On the 2-3rd day an intramuscular hematoma appears. In case of severe bruise of the joint, severe hemarthrosis develops, which can increase in the first 2-3 days, which indicates ongoing internal bleeding due to severe damage to the elements of the joint. Severe bruises in all cases require an in-person examination, x-rays, measures against infection and symptomatic treatment.
General principles of medical tactics for hematomas
In the vast majority of cases, the injuries are superficial and the accumulation of blood in the tissues is insignificant. Often, medical intervention (in particular, drainage of the hematoma) is not required, since after a certain time the hematoma disappears on its own. This process occurs due to the gradual lysis (destruction) of plasma and blood cells that formed the hematoma.
The rate of resorption of a hematoma after a bruise depends on:
- the amount of blood shed;
- age (in the elderly, hematomas resolve more slowly than in children or young people);
- associated infection (in this case, the hematoma does not resolve, but suppurates);
- condition of the vessels (if they are pathologically fragile, a repeated outpouring of blood into the tissue may occur in the same location, and the hematoma simply does not have time to resolve).
Before wondering how to treat a large hematoma on the arm, you should remember that large vessels pass through this area, and the outpouring of blood that formed the hematoma may signal damage to the walls of these vessels and the threat of more pronounced bleeding.
Less commonly, hematomas occur:
- in muscles;
- in fatty tissue;
- in the thickness of the parenchymal organ;
- under the meninges;
- in brain tissue.
They are united by a common feature: blood rushes into the tissue according to the principle of least resistance. Knowing the characteristics of the tissues, it is possible to determine with great confidence where the hematoma could have formed. The success of treatment largely depends on this factor.
Medical tactics for the accumulation of blood in tissues depend on a number of nuances:
- localization of hematoma;
- patient's age;
- concomitant diseases.
Treatment of a small hematoma on a child’s head should be given no less attention than a large hematoma on the anterior abdominal wall of an athlete. And an acute infectious disease can lead to the fact that when even a small amount of blood accumulates in the tissues, suppuration can occur.
Treatment of hematoma suppuration must begin immediately as soon as the development of a pathological process is suspected. Suppuration of a hematoma can lead to very serious complications, in particular, provoke necrosis of soft tissues, damage tendons, bone, muscle and joint tissue. Hematoma is a cavity filled with blood clots. A hematoma occurs due to extensive injuries. Small hematomas do not require special treatment and, in most cases, resolve on their own. Extensive hematomas require medical intervention.
Causes of suppuration
A hematoma is formed as a result of mechanical damage to soft tissue. This happens when there is a strong impact. Blood that accumulates in soft tissues, in cases where it does not resolve on its own, leads to its suppuration. The only reason for the suppuration of a hematoma is the lack of timely medical care for extensive, large hematomas. The likelihood of suppuration increases when infectious pathogens enter the body and in the presence of severe chronic diseases associated with metabolic disorders, for example, diabetes mellitus and hormonal imbalance.
Clinical picture
Symptoms of hematoma suppuration:
- pain at the site of hematoma formation;
- increased body temperature;
- bradycardia;
- attacks of dizziness;
- deterioration of the general condition of the body;
- signs of intoxication (nausea with vomiting);
- if the hematoma is located under the skull - blurred vision, decreased hearing acuity, migraines.
Diagnosis of pathology
Diagnosis of a festering hematoma is based on:
- examining the patient, collecting a detailed history, studying complaints;
- taking a blood test;
- Ultrasound;
- magnetic resonance imaging;
- computed tomography (if the hematoma is located under the skull).
How to treat?
Treatment is selected by the doctor individually for each patient, depending on the location of the festering hematoma, its size and the presence or absence of complications. To relieve severe inflammation and relieve swelling from soft tissues, cooling compresses are prescribed. If the purulent focus has not yet matured, it is allowed to use warm compresses, which promote the active resorption of blood clots. A conservative method of treating a suppurating hematoma involves the patient taking antibiotics, which are selected based on the results of bacteriological culture and determining the type of infectious microflora that caused the suppuration. Medicines with analgesic and anti-inflammatory effects are selected individually, depending on the severity and characteristics of the symptomatic picture. When the purulent process has already matured, the only method of treatment is its opening. The procedure is performed using general or local anesthesia, depending on the extent of the inflammatory, purulent process and the depth of the lesion. Opening the purulent contents involves cutting the skin, carefully removing the purulent masses, followed by washing the cavity with antiseptic drugs. After the operation to open the festering hematoma, a bandage with an antiseptic solution is applied to the wound. The patient is prescribed antibiotics to suppress the infectious microflora remaining in the body, and immunoglobulin drugs to increase the body's protective functions, thereby preventing re-inflammation with the formation of a purulent focus.
Conservative and surgical methods of treating hematomas
Conservative treatment of a hematoma means providing first aid and eliminating the resulting accumulation of blood.
As first aid for visible hematomas, exposure to low temperatures is used. For this purpose, any container with cold contents is applied to the site of the hematoma. This could be ice from the refrigerator, a cold spoon (for a small hematoma - for example, in the eye area) or even a carton of milk from a refrigerated display case.
After a few days, in order for the hematoma to resolve faster (for example, if the patient asks how to remove a hematoma on the leg as soon as possible), physiotherapeutic methods can be used: UHF; Microwave and others.
Surgical treatment of hematomas is carried out if they are large in size, due to which there is pressure on surrounding tissues; or with symptoms of suppuration.
Opening and drainage of a subcutaneous hematoma can be carried out in a dressing room. The contents are evacuated, the resulting cavity is washed, and a sterile bandage is applied.
Hematomas that occur under the meninges and in the internal organs require emergency surgical intervention performed in hospital operating departments. During surgery, liquid or clotted blood is removed and drained. Blood is an excellent breeding ground for microorganisms. Therefore, after opening large hematomas, even if there were no signs of infection, broad-spectrum antibiotics are prescribed.
Surgeon's help with bruises and hematomas:
If pain is very severe, it is necessary to consult a surgeon for examination; if necessary, the patient will be prescribed analgesics. If a large hematoma has formed at the site of the bruise, it is necessary to open it - extracting liquid blood with a syringe and applying a pressure bandage. Opening the hematoma is carried out only by a surgeon to avoid infection! By opening large hematomas, the formation of scars can be avoided. Thus, when a finger is hit with a hammer (a classic case of domestic injuries among men), hemorrhage develops under the nail. The growing hematoma lifts the nail, causing significant pain. If in the first hours after a bruise you remove the blood that has flowed under the nail, you can save the nail. Also, in such cases, an x-ray of the hand is recommended to exclude a possible fracture of the phalanx of the finger.
If bleeding at the site of the injury resumes, then the hematoma is opened, or the bleeding vessel is tied up or a vascular suture is applied. If the hematoma festers, it must be urgently opened and drained; the wound is left with drainage to drain purulent contents.
The accumulation of blood in the joint can cause chronic synovitis and bursitis, therefore, if a bruise causes hemorrhage into the joint (hemarthrosis), it is necessary to extract blood from the joint cavity. To speed up the healing of moderate and severe joint bruises, physiotherapy, massage, and exercise therapy are recommended from the 3-5th day. Competent treatment tactics, taking into account concomitant pathology and an individual approach to each patient in our clinic are the key to successful treatment of this pathology.
Treatment of hematoma on the head of a child
Due to excessive mobility, children often get injured. A large percentage of childhood injuries are head contusions, which are often accompanied by hematomas and the formation of “bumps.”
First aid involves applying a cold object to the site of the hematoma. This should be done in the first few hours. Important: given the imperfection of thermoregulation in children (high sensitivity to low temperatures), the use of cold in children should be dosed - about half an hour and at intervals.
We recommend visiting our clinic’s website https://www.dobrobut.com/, where you will learn in more detail about the causes and consequences of hematomas in children.
Related services: Departure of an emergency team Departure of a specialized pediatric emergency team