Surgical Complications

Figure 6.5 Algorithm for expanding hematoma
Figure 6.5 Algorithm for expanding hematoma
Hematoma
  • Risk of bleeding greatest in first 48 h (especially in immediate postoperative period)
  • Provides medium for bacteria, prevents wound healing, ↑ wound tension (± dehiscence)
  • Two types of hematoma: stable and expanding
  • Stable hematoma
    • Non-expanding ecchymotic firm to fluctuant mass with sensation of pressure
    • Small, stable, non-infected, and not compromising tissue viability → no surgical intervention necessary (observation w/ warm compresses to hasten resorption)
  • Expanding hematoma (Figure 6.5)
    • Enlarging ecchymotic fluctuant to firm mass with new onset pain (often throbbing)
    • Medical emergency if expanding hematoma in periorbital or cervical locations
  • If very early hematoma (warm, swollen, fluctuant) → intervention recommended to prevent further progression (same intervention as for expanding hematoma)
  • If late hematoma (liquefactive stage, 7–10 days after formation) → may aspirate w/ needle