A hematoma is a localized collection of blood outside of a blood vessel, similar to a deep bruise that forms a mass. This accumulation occurs when small blood vessels are damaged during surgery, allowing blood to leak into surrounding tissues. Preventing this complication is important because a hematoma can delay wound healing, increase the risk of infection, and cause discomfort and swelling. Avoiding a hematoma requires careful attention to instructions both before and after the operation.
Pre-Surgical Steps to Minimize Bleeding Risk
Controlling bleeding begins well before surgery by adjusting medication and supplement intake. Disclose all prescription medications, over-the-counter drugs, and herbal supplements to your surgical team, as many substances interfere with clotting or platelet function, increasing post-operative bleeding risk.
Aspirin, NSAIDs (like ibuprofen), and prescription blood thinners (such as warfarin) must be stopped for a specific period before the procedure, often five to ten days. The exact timing depends on the drug and the surgery. Acetaminophen is generally safe for pain relief during this time, as it does not affect clotting.
Numerous dietary and herbal supplements also possess blood-thinning properties and should be discontinued, usually for up to two weeks. Examples include:
- High-dose Vitamin E
- Fish oil (omega-3 fatty acids)
- Garlic
- Ginger
- Ginkgo biloba
Additionally, addressing uncontrolled hypertension is necessary, as high blood pressure can increase bleeding during or immediately after the operation.
Immediate Post-Operative Pressure and Drainage
The acute prevention phase occurs in the operating room and recovery unit during the first 24 to 48 hours. Pressure is the primary tool used to limit blood accumulation. Compression bandages or specialized garments provide continuous external force, acting as a tamponade to collapse small, injured blood vessels and reduce the space for blood to pool.
Surgical drains are frequently utilized to remove excess blood and fluid before a hematoma forms. Closed-suction systems, such as Jackson-Pratt drains, actively pull fluid away from the site. Drains typically remain in place until the output volume decreases significantly, indicating the initial bleeding risk has subsided.
In the initial hours, cold compression or ice packs are often applied to the surgical area. The lower temperature encourages local vasoconstriction, narrowing blood vessels and reducing blood flow into the tissue. Maintaining specific positioning, such as elevating a limb, further assists by using gravity to manage localized blood pressure and minimize swelling.
Managing Activity During Home Recovery
Once discharged, managing physical activity is the primary way to prevent delayed hematoma formation. Strictly follow all lifting restrictions, often set at five or ten pounds for the first few weeks. Lifting, pushing, or pulling heavy items causes a sudden spike in internal pressure, risking the tearing or re-opening of fragile blood vessels.
Avoid strenuous activity or exercise that significantly raises your heart rate and blood pressure during early recovery. Elevated blood pressure increases the force against healing capillaries, making it easier for blood to leak. Patients should also avoid excessive heat, such as hot tubs or saunas, because heat causes vasodilation, widening blood vessels and promoting increased blood flow to the surgical area.
Sudden increases in abdominal or chest pressure, such as from coughing, sneezing, or straining during bowel movements, transmit stress to internal suture lines. To mitigate this, brace the surgical incision firmly with a pillow or hand during these unavoidable actions. While strict rest is required initially, gentle, approved movements are encouraged over time to promote circulation, but must be cleared by your surgeon.
Recognizing When to Seek Medical Attention
Even with preventative measures, a hematoma can occur, and recognizing signs requiring professional intervention is important. A problematic hematoma is typically indicated by a rapid increase in swelling over a period of hours. This swelling is usually accompanied by a firm, tense, and painful lump disproportionate to expected post-operative discomfort.
While normal bruising is expected, a hematoma often presents with quickly spreading skin discoloration or a feeling of tautness over the surgical site. The pain may be severe and not relieved by prescribed medication. If the blood collection is large, it can put excessive pressure on surrounding tissues or the incision, potentially leading to wound separation.
Immediately contact your surgical team if you observe these signs, especially if swelling is rapidly expanding, or if you develop a fever or notice pus drainage. If surgery was performed on the neck, new or worsening difficulty breathing or swallowing requires immediate emergency medical attention. Prompt diagnosis and treatment, such as aspiration or surgical drainage, are necessary to prevent complications and ensure proper healing.