Progressive Tension Sutures for Hematoma

It is important that in the past 15 years, clinicians have recognized that there was much more to the cause of hematoma than just a delay in diagnosis. Although there are a variety of causes for a hematoma, all of them can lead to hematoma if left untreated. The main causes are arterial tear, traumatic fracture, and intimal tear, which were most likely to be neglected in the past. It is important for clinicians to be aware of these causes and educate patients about how they can prevent or reduce hematoma formation and its consequences.

An estimated 10 million adults receive treatment for an epidural hematoma annually in the United States. Most patients experience no complications but 25% to 52% of patients will require hospitalization and may require surgical intervention. Epidural hematomas were not associated with chronic neurological deficits.

A hematoma, an extramedullary mass of blood, can involve the central nervous system. Hematomas may be a manifestation of vascular malformations, arteriovenous malformations, or arteriovenous fistulae. Hemorrhage or hematoma in adults is uncommon, but its rarity may be exaggerated because of the tendency of hematomas to become asymptomatic when they are small relative to other symptoms. Unlike typical hematomas, extravascular hematomas of the central nervous system may result in signs and symptoms suggestive of brain infarction.

Data from a recent study has found no instances of hematoma cure when using the usual modalities. However, due to the severity of the condition in cases which were not adequately treated, we would strongly support consideration of further treatment, particularly in the case of large hematoma.

This is one of the earliest signs of hematoma, and it can be seen before pain or the development of skin changes. The symptoms should be prompt; if they are not present after one hour, a hematoma will probably have developed even if nothing was done to cause it.

There is no clear evidence of any benefits of conservative management of hematoma compared with surgical drainage. The most commonly recommended treatment is embolization if the source can be determined (hematoma is embolized in the vast majority of cases).

In a recent study, findings show no significant difference in the use of the three different tension sutures. Although the use of the three sutures increased the pain at the initial use for a short period, this did not make a difference for the final level of pain relief. Considering the benefits of the tension sutures for relieving the pain in the initial usage and decreasing postoperative morbidity, these results indicate that using tension sutures as an additional treatment can be recommended in patients with tension suture(s) following surgery.

Patients usually recover completely, with almost no disability and no long- term complications. However, there are exceptions, and some patients still have long-term disability as a result of severe neurological deficits, post-hematoma hydrocephalus, and hematoma expansion into the brain parenchyma. In addition, a hematoma that crosses the corpus callosum may spread and cause a progressive deterioration of consciousness. Patients with symptomatic hematoma or hematoma associated with post-traumatic complications should be brought to specialist centers, especially neurological surgeons, and urgent CT imaging is recommended.

Tension suture placement improves cosmesis in the setting of a hematoma and enhances healing. Future studies should address the impact of suture tension on pain relief, length of hospitalization, and quality of life.

We confirmed the previously reported association of SLE and a HBD with hematoma. Results from a recent clinical trial also shows the necessity of the use of family history in order to be properly managed: even a single family member with SLE poses the risk of serious hematomas.

Tension sutures are the most recent, effective, and safe method of treatment for hemorrhage caused by pelvic fractures. Tension sutures are highly effective and are especially useful in patients requiring surgical intervention immediately following a pelvic fracture. Tension sutures may be used when laparotomy is contraindicated, such as in patients with active bleeding from the pelvis, unstable pelvic structures, or advanced pelvic organ prolapse.