Bleeding Control in Wound Care: Debridement of a Large Hematoma

 

Benefits of Bleeding Control with a Topical Hemostatic Agent in Wound Care – Segment 2 – Large Hematoma on Coumadin

So let’s just look at a few things about some of these patients that I’ve used a lot of this on. This is an interesting wound and I’m sure you guys come across this patient. Lymphedema, more rotund type patient on Coumadin for atrial fibrillation, smacks her leg, gets a big hematoma in that area. When you see somebody that, and I did this right in the office, has a big hematoma and the skin becomes ischemic they bleed underneath. Then the skin gets lifted off the subcu, it’s hard for the skin to get a vascular supply and it can become ischemic. It gets purple and black which has to be debrided away. We don’t just leave it. It’s not going to resorb, you’re not going to have new skin growth over that, that has to be debrided out. So you get a little nervous because you don’t know what exactly is under there but you have to be able to debrided that away.

Now you have confidence that you can do some debridement and you’ll be able to put the Omni-Stat on. Look at how fast that was until it stopped bleeding. The stuff that’s not in contact with the wound, that has not formed that plug, all those loose granules on the side, I just wipe them away. There’s no reason to leave them there, you want to wipe off any excess granules that are there. Do I irrigate that away? I do not irrigate that away. I just take gauze, or I’ll take the back of my pickups and just scrape whatever is loose around the wound and I do remove that. Now there are some areas there that I didn’t cover, but you want to cover the wound bed completely. Get a little bit on your wound edge, get it in all those nooks and crannies, make sure it fills there. For her I just put on a couple ABD Pads, an Ace bandage, excuse me a Coban™ around it, to hold pressure for a couple of minutes, and I went and saw another patient while this was going on. That I think is the beauty of that that you don’t have to sit there and just hold pressure. You can put it on, go see your patients, and come back and then you can see that you have coagulation going on.

Now obviously when you have wounds like that there are other things that you need to do. Sometimes they’re deeper, sometimes they require a Wound VAC that you put on to help, multi-layer compression, then you’re sending them out to get their dopplers done and you’re putting absorptive dressings under the multi-layer compression and things of that nature. These can be deep wounds but all of that devitalized black purple tissue, all that hematoma, that coagulated blood needs to be removed from that area so that you can see the depth of your tissue but it is very oozy.

Presented by Matthew Regulski, DPM

Dr. Matthew Regulski, DPM is a podiatric surgery specialist in Browns Mills, NJ. Dr. Regulski completed a residency at Main Line Health System – Phila, PA. He currently practices at Ocean County Foot & Ankle Surgical Associates, P.C. and is affiliated with Community Medical Center.

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