Hematoma Resolution Solution

Clinical Problem

If not resolved, hematomas can delay wound healing and create an environment that is susceptible to infection. Three trauma wound cases are being presented with hematomas. Patient 1, an 85 year old female that fell on icy steps on the left knee/leg. Patient 2, a 36 year old male that fell off a ladder on the left leg developing cellulitis. Patient 3, an 80 year old female fell twice on the left knee/leg due to vertigo causing cellulitis.

Past Management

An antibiotic ointment and non-adherent dressing was applied daily for 1 week on patient 2’s laceration and 3’s laceration after second fall.

Current Clinical Approach

Extra thick polymeric membrane dressings with or without silver were applied with polymeric membrane cavity filler or WIC silver rope. Silver dressings were applied for infection or suspect of infection. All wounds were conservatively sharp debrided and compression was applied to reduce swelling. The dressings were changed every other day to 3x per week, by the health care provider or caregiver. Wounds were cleansed with normal saline per facility policy. A barrier cream was applied on the periwound skin of patient 2 for previous maceration.

Patient Outcomes

Polymeric membrane dressings provided significant outcomes. The dressings helped to dissolve the old blood, promote autolysis, enhance granulation growth and provide an optimal moist healing environment. Hematomas dissolved as early as 11 days to 41 days depending on the extent of tissue compromise. Pain was significantly reduced in all 3 patients. Wounds reached wound closure for patient 1 and 2. Patient 3’s wound was almost closed before being discharged to a nursing home.

Conclusions

Polymeric membrane dressings helped to resolve hematomas, a problem often occurring after trauma. Polymeric membrane dressings are the standard of care with this facility for hematoma management.