Surgery intentionally creates trauma to tissues, disrupting blood vessels and other structures. This triggers the body’s healing response. While most surgical recoveries proceed smoothly, tissue repair can sometimes lead to complications. Understanding common post-operative issues helps patients recognize when they need to seek medical guidance.
Defining a Hematoma in Surgical Recovery
A hematoma is a localized collection of clotted or partially clotted blood that accumulates outside of blood vessels, usually within the surgical site or surrounding tissue. This occurs because blood vessels damaged during the operation may continue to ooze blood after the incision is closed. The blood collects in a pocket, forming a distinct mass.
A hematoma is distinct from a common bruise (ecchymosis), where blood spreads thinly beneath the skin surface. It is also different from a seroma, which is an accumulation of clear, yellowish serous fluid rather than whole blood. While both cause swelling, a hematoma contains thickened, clotted blood. The volume can range from a minor, self-limiting accumulation to a large mass requiring medical intervention.
Identifying the Symptoms
A hematoma is characterized by visible and palpable signs near the surgical incision. Patients often notice localized swelling that seems disproportionate to expected post-operative puffiness. When touched, the area may feel tense, firm, or like a distinct, rubbery lump beneath the skin.
The pressure from the pooled blood causes pain greater than the usual recovery discomfort, often described as tightness or fullness. Observable skin changes include discoloration, presenting as a deep purple, blue, or red hue, similar to a severe bruise. In some cases, a small amount of blood may even leak between the skin sutures.
Factors That Increase Risk
Several systemic and procedural factors increase the risk of developing a hematoma after an operation. One primary cause is the use of certain medications, particularly blood thinners or anticoagulants, which are designed to reduce the blood’s clotting ability. Antiplatelet therapies and non-steroidal anti-inflammatory drugs (NSAIDs) can also elevate the risk of post-operative bleeding.
Certain patient health conditions also affect the body’s hemostasis, or ability to stop bleeding. These include pre-existing clotting disorders, uncontrolled high blood pressure, and chronic conditions like diabetes or hepatorenal insufficiency. These factors can hinder the natural coagulation process necessary to seal off tiny, damaged vessels after surgery.
Procedural factors, such as the complexity of the operation, also play a role in hematoma formation. Surgeries involving extensive tissue dissection or those in highly vascular areas, like the face or neck, carry a naturally higher risk. A longer operative duration can also be associated with an increased likelihood of this complication. Sudden physical activities like vigorous coughing, straining, or vomiting immediately following the procedure can cause a spike in blood pressure, potentially dislodging forming clots and restarting bleeding.
Management and Expected Resolution
The medical approach to a post-operative hematoma depends on its size, location, and stability. Small, non-symptomatic hematomas are often managed conservatively with observation. The body is typically able to slowly absorb the collected blood over several weeks to months, much like a severe bruise.
Conservative care may involve rest, applying cold compresses, compression dressings, and elevating the affected body part to minimize swelling. Acetaminophen is recommended for pain management, but patients should avoid NSAIDs unless cleared by their surgeon, as these can increase bleeding risk.
If a hematoma is large, painful, or expanding, medical intervention is necessary. This may involve a minimally invasive procedure like needle aspiration to drain the accumulated blood and relieve pressure. Very large or rapidly growing hematomas may require surgical evacuation in the operating room to remove the clot and seal the source of bleeding. Immediate contact with the surgeon is necessary for rapidly expanding swelling, new signs of infection, or difficulty breathing, especially after neck surgery.