Hematoma Debridement : Case Study

Bleeding Control of a Hematoma Pre and Post Surgical Debridement with Hemostatic Gauze and Granules

Hematoma before debridement

Image 1: Hematoma before treatment

Male patient, late 70’s with Lymphedema, previous Deep Vein Thrombosis (DVT), and chronic COPD who is severely obese and on Coumadin suffered blunt trauma to the outside of his left calf when an IV pole fell onto his leg. The wound went untreated for two weeks until the patient was brought into the wound care office on a Wednesday and presented with this large hard necrotic bleeding hematoma and severe cellulitis. On Thursday the patient came back to the wound clinic for surgical evaluation. The wound had undermined tunneling under the skin and it was deemed the patient needed to be taken to the operating room for surgery. (Image 1 right)

 

 

Hematoma with Hemostatic Gauze

Image 2: Hematoma with hemostatic gauze to control arterial bleed

The patient was then admitted to the hospital for administration of IV antibiotics and further surgical planning for evacuation of the hematoma and necrotic tissue. During pre-op, at the first dressing change, a large chunk of the hematoma came off causing a spurting arterial bleed. The surgeon placed OMNI-STAT® Hemostatic 4×4 Gauze in place to get the bleeding under control followed by application of ABD pads & heavy multi-layer compression bandaging. 

Saturday the patient returned to the OR for surgery and the hemostatic gauze was still in tact having silenced the arterial bleed for two days. (Image 2 right)

 

After the hemostatic gauze was removed, the surgeon debrided the wound removing all dead, devitalized, gangrenous, and necrotic tissue. OMNI-STAT® 3g Granules were then used to achieve hemostasis.

Once hemostasis was achieved, excess granules were gently irrigated and a GRANUFOAM™ Dressing was put in place followed by a wound V.A.C.® for two days. (Images 3 & 4 below)

Hematoma after Debridement

Image 3: After debridement use of hemostat granules to achieve hemostasis

After Debridement with hemostat granules to control bleeding

Image 4: Hematoma after debridement with dressing & wound V.A.C.

After two days the wound V.A.C.® was changed and re-applied and the patient was discharged. Five days after that, 9 days post-surgery, the patient returned to the wound clinic where the wound V.A.C.® was removed again. The patient was then debrided once again and additional OMNI-STAT® 3g Granules were used to control bleeding and exudate from the wound prior to the wound V.A.C.® being re-placed. (Images 5 & 6 below).

Hematoma debridement 9 days post surgery

Hematoma debridement 9 days post surgery

Image 5: Hematoma further debridement 9 days post surgery

Hematoma  after further debridement showing hemostat granules

Image 6: Further use of OMNI-STAT® hemostat granules used to control bleeding and exudate

The patient will continue to be seen twice a week on Monday and Thursday.

The Author

Dr. Matthew Regulski, DPM is the Medical Director of Wound Institute of Ocean County and is Co-Director of The Center for Wound Healing and Hyperbaric Medicine at Community Medical Center in Toms River and is the Wound Care Center Director at Kimball Medical Center.

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101 Avenue of the Americas,
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New York, NY 10013,
USA

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