After surgical procedures, the body initiates a healing process, which can sometimes include the formation of a hematoma. These blood collections are common in post-operative recovery. Understanding them helps patients navigate their healing journey by clarifying what a hematoma is and what to expect if one develops.
Understanding Hematomas
A hematoma is a collection of blood that has exited blood vessels and accumulated in a specific area, often forming a clotted mass. This differs from a simple bruise (ecchymosis), which involves blood spreading diffusely under the skin without forming a distinct lump. Hematomas result from bleeding into tissues, cavities, or organs, leading to localized swelling and sometimes pressure. While they can occur in various body parts, such as a subdural hematoma in the brain or a subungual hematoma under a nail, this article focuses on those developing at a surgical site.
Why Hematomas Occur After Surgery
Surgical procedures inherently involve incisions and manipulation of tissues, which can damage small blood vessels. Even with meticulous surgical technique, capillaries and venules may sustain injury, causing blood to leak into the surrounding tissues. The body’s natural clotting mechanisms usually manage this bleeding; however, sometimes the bleeding can be more extensive or the clotting insufficient.
Certain factors can increase the likelihood of hematoma formation post-surgery. Patients taking anticoagulant medications, commonly known as blood thinners, face a higher risk because these drugs reduce the blood’s ability to clot effectively. Pre-existing bleeding disorders, where the blood does not clot properly on its own, also contribute to this risk. Additionally, the body’s natural inflammatory response to surgical trauma can sometimes lead to increased blood flow and capillary fragility, potentially exacerbating bleeding into the surgical site.
Recognizing a Surgical Hematoma
A surgical hematoma is identified by specific signs and symptoms at or near the operative site. Localized swelling is a common indicator, appearing as a noticeable bulge or lump that feels firm or rubbery to the touch. This swelling often accompanies tenderness or pain, which can range from mild discomfort to significant agony depending on the hematoma’s size and location. Discoloration of the skin over the affected area is another characteristic sign, progressing through various shades from reddish or purplish to darker blue, black, or yellowish-green as the blood breaks down. The area may also feel warmer than the surrounding skin due to the inflammatory response and blood accumulation.
Management and When to Seek Care
The management of a surgical hematoma depends largely on its size, location, and the symptoms it causes. Small hematomas often resolve on their own as the body gradually reabsorbs the pooled blood, a process that can take several weeks to months. In such cases, healthcare providers may recommend observation and perhaps applying cold compresses initially to help reduce swelling and discomfort.
Larger or rapidly expanding hematomas, however, might require more active intervention. For significant hematomas that cause considerable pain, pressure, or threaten tissue viability, a healthcare provider might decide to drain the blood. This can involve a needle aspiration, where a needle is used to withdraw the fluid blood, or a surgical evacuation, where an incision is made to remove the clotted blood.
It is important to seek prompt medical attention if you experience:
Rapidly increasing swelling
Severe or worsening pain
Signs of infection such as fever, warmth, redness spreading from the incision, or pus drainage
Numbness or tingling in the affected area
Any impairment of function