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What is a post operative hematoma?

Postoperative hematoma or hematoma after surgery is a pocket of blood that accumulates in a post-surgical site. It is an undesirable— but usually non-life threatening— complication that may arise within several hours and days after a surgery. Examples of postoperative hematoma include:

• hematoma on vagina after childbirth (post episiotomy)
• hematoma after a c-section surgery
• subcapsular hematoma after a cholecystectomy (a surgery to remove gallbladder)
• hematoma after an abdominoplasty
• hematoma after a breast augmentation
• hematoma after a facelift surgery
• oral hematoma after a dental surgery

Although hematomas that develop in hours after the surgery may be the surgeon’s fault or due to poor aftercare by the patient, most post-op hematomas are a complication that is out of anybody’s control.

Causes of a postoperative hematoma

Before completing a surgery, surgeons make sure that all bleeding vessels are closed before closing the incision. This is typically done by cauterizing with an electrical current to form a clot. On occasions, this clot falls off postoperatively, allowing the vessel to bleed and create a sac of blood in the post-surgical site and its surrounding tissues.

Risk factors of a postoperative hematoma include preoperatively taking certain drugs such as aspirin and a variety of non prescription blood thinners and intraoperative administration of heparin. Out of this reason, doctors generally ask patients to avoid or stop such medications for several weeks before the surgery and occasionally prescribe protamine postoperatively to reverse the heparin’s effects that may lead to formation of a hematoma. Another risk factor is a family history of bleeding disorders and uncontrolled hypertension.

Treatment of a postoperative hematoma

As with other hematomas, postoperative hematoma normally dissolves spontaneously in several days. More severe or larger hematomas may require a follow-up surgery by re-opening the wound to drain the collection of blood and clamp down the bleeding vessels if the bleeding is still active. Your surgeon would tell you when this surgery is needed. Medications prescribed are typically analgesics and anti-inflammatory drugs to provide comfort such as ibuprofen (Motrin) and acetaminophen (Tylenol). Additional medications that help “dilute” the blood clot faster may also be given.