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Hematoma after Surgery

Hematoma is a sac of blood that gets accumulated at a surgical site, after surgery. This accumulation of blood leads to pain, inflammation, and discoloration of the skin around the surgical wound. Mishaps during the surgery, improper post-surgery care, etc. can cause hematoma.
Kanika Khara
Last Updated: Mar 12, 2018
Hematoma after surgery or postoperative hematoma is basically a localized collection of blood at the surgery site. It is defined as the collection or pooling of blood under the skin, in body tissues or an organ.
Hematoma is a common potential post-surgery complication, and is commonly seen after a face-lift surgery. When capillaries, arteries or veins rupture, blood oozes out of the blood vessels and flow into the surrounding tissues, causing a pool of blood. Clot formation may take place, which may harden into lumps. These lumps are actually blood sacs that aim to keep the bleeding to a minimum level, without spreading.
Hematoma may develop a few hours (or even days) after the surgery, due to some kind of damage to the surrounding blood vessels during the surgery, or as a result of poor aftercare of the patient. Some of the common examples of hematoma after surgery include episiotomy (surgical incision of vagina during childbirth), c-section surgery, cholecystectomy (surgical removal of gallbladder), abdominoplasty (cosmetic surgery of the abdomen to remove wrinkles and tighten the skin over the stomach), breast augmentation, facelift surgery, or even a dental surgery.
What Causes a Hematoma
A hematoma after surgery can be caused by various factors such as:
Mishap during surgery
If the surgeon fails to seal the blood vessels completely during the surgery, blood will gush out into the surrounding tissues, and result in hematoma. Sometimes, during the course of the surgery, the surgeon may accidentally injure some blood vessels, which may also result in hematoma.
Vomiting/Coughing
Falls and other activities causing stress on the wound can cause hematoma, however, even simple actions like coughing, sneezing, vomiting, etc. immediately after the surgery, can cause hematoma, especially in facelift surgeries. Even if one sneezes, coughs or vomits, it should be done without straining the surgery site.
Anticoagulants
The risk of developing a hematoma after a surgery, is higher in those who take anticoagulating drugs like ibuprofen and aspirin. This is why patients are asked to stop taking these medicines way before the surgery.
Strenuous activities
Those who begin strenuous activities soon after the surgery, have a higher risk of developing a hematoma. Moreover, carrying out activities like lifting heavy objects, bending, etc. can cause strain on the surgery site, and may cause the capillaries in that region to break.
Stress
Stress after a surgery can cause one's blood pressure to rise, which in turn causes the blood vessels to rupture. This happens because after surgery, the patient's blood vessels are more sensitive, and can break by rise in blood pressure. Thus, it is important for the post-operative patient to be given good care after the surgery. Emotional support will also reduce unnecessary stress.
Hypertension or other bleeding disorders can also cause hematoma after a surgery.
Symptoms of Hematoma
Symptoms usually appear within the first 24 hours, however, can arise after 3 weeks of the surgery as well. The condition is usually characterized by pain, swelling, inflammation, or a feeling of fullness in the affected area, along with the overlying skin turning blue or purple.
In mild cases, the bleeding is minimal, and stops or gets reabsorbed on its own, like the natural blood clotting mechanism. Blood clots will be formed, which harden and feel like lumps under the skin. If infection sets in, fever will be accompanied by excruciating pain.
However, in severe cases, the hematoma gets large enough to compress the tissues and prevents oxygen from reaching the skin, resulting in the eventual dying of skin. This may further increase the risks of having other complications like infection, wound separation, and necrosis (the localized death of living cells).
Treatment
The more the amount of blood that has leaked into the surrounding tissues, the bigger will be the clot formation, and severe will be the hematoma.
Hot and Cold Treatment
Often mild cases of hematoma get reabsorbed, and do not require surgical intervention. In such cases, hot and cold treatment is used to alleviate mild hematoma. Ice packs are used for vasoconstriction, which causes the blood vessels to constrict, and reduces blood flow. Thus, bleeding and swelling will reduce after the ice pack method. This is continued for two days, until the swelling subsides.
Next, the hot towel treatment is followed, wherein a warm towel is applied on the hematoma. Heat speeds up the healing process, by causing internal bleeding to cease and promoting reabsorption of the clot. Cold compress again follows the heat treatment, and is to be alternated till the discoloration and inflammation fades away. Anti-inflammatory drugs and analgesics may be given to reduce inflammation and pain. Massaging the inflamed area will also help.
Drainage Method 
In some cases, the hematoma does not subside by the hot and cold treatment alone. In such cases, the surgeon will manually drain the collected blood. The surgeon will use a sterile needle to drain the blood, by a process called aspiration. An enzyme called hyaluronidase may also be injected to speed up the reabsorption of blood.
Surgical Method
However, severe cases of hematoma require surgical intervention, because if left untreated, they can result in infection, scarring and even necrosis (death of tissues). Another surgery will be scheduled by the surgeon to remove the hematoma. During the surgery, the wound will be re-opened, so as to remove the clot via saline irrigation. The blood vessel causing the problem will have to be identified and then clamped. The wound is then sutured again. The patient will have to take extreme care after the surgery to prevent further hematoma.
If you think you are developing a hematoma near the surgical site, it is important to call up your doctor and mention the symptoms correctly. If necessary, have the doctor take a look at the bruised site. Meanwhile, make sure you take enough precautions and do nothing to trigger hematoma formation.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a substitute for professional medical advice.