The mechanism of the appearance of hematomas and the etiology of the processes preceding this have a close relationship. The traumatized hematoma in this case is no exception. In order to understand the causes of its occurrence and learn about treatment methods, you must familiarize yourself with the following information.
A bit of anatomy
The skin has 3 layers with its own special properties: epidermis, dermis, hypodermis (subcutaneous fat layer).
The epidermis is the uppermost and thinnest layer, there are no blood vessels in it and only a few layers of cells. It eats due to the diffusion of substances from the lower deep layers of the skin. With closed injuries, it remains intact. Its function is protective.
Dermis, or the skin itself, is the fiber of the connective tissue. There are already some nerve endings and vessels in the form of capillaries. Derma plays a role in the appearance of subcutaneous hematomas, but there is practically no hemorrhage. This is due to the fact that connective fibers are densely built and cavities with blood are nowhere to be formed here. The nerve endings respond to pain during trauma.
Subcutaneous fat is the deepest layer. Built in the form of cells containing sections of fat, separated by connective tissue septa.
Here are concentrated nutrients and small vessels. In the areas there is a deposition of food or there is a consumption, if necessary. Hematomas form here, because adipose tissue is softer and easily extensible for cavities. Blood is also poured here in case of damage to larger vessels.
Separation of concepts
With skin lesions, intra- or subcutaneous hemorrhages can occur , which are called differently, often considering them to be an analogy. But they are all different. The injury is called a bruise, and a hematoma, and a bump, but these are not synonyms. For example, hematoma and bruising: they only have a common cause - external or internal exposure or disease. But with a hematoma, there is always a cavity where the blood has poured out and the structure of the tissue is damaged. It appears due to stratification of the tissue.
If there is no cavity, this is not a hematoma, it can occur not only in the skin, but also inside the organs. For example, in the cranial cavity by localization, there are:
- epidural (extradural) hematoma - between the bones of the skull and the dura mater;
- subdural hematoma (under the dura mater) ;
- subarachnoid hematoma (under the pia mater);
- intracerebral, or parenchymal in the substance of the brain, subcutaneous hemorrhage on the head is often called a bump - in adults.
Bruising is also a hemorrhage in the soft tissues, but the structure here is not broken, and the cavity does not occur. In vernacular, this is called a bruise.
A bruise is only a colloquial, but not a medical term. It is not used in official documents. Some people like to show off medical terminology and call bruising a hematoma, although this is fundamentally wrong. To be precise, this is hemorrhagic skin soaking.
Why is it important to separate these concepts? Because they have different consequences, treatment and severity. The degree of contusion can determine the appearance of a bruise or hematoma.
Degrees of bruises
Bruises are 3 degrees. With the 1st degree there will be only a bruise, which will resolve itself and is not dangerous. Other degrees lead to hematomas. Hematomas are unpredictable, they themselves do not disappear, can be complicated and require treatment. They can occur without injury, when the vessel ruptures spontaneously - this is a spontaneous hematoma. The skin at the injury site goes through all stages of color change: red, red-blue or yellowish-green.
- The first degree of injury is a slight bruising. It becomes noticeable the next day. He is slightly sore and there is no edema here.
- The second degree - the pain appears immediately and the site of the swelling swells. A bruise occurs within 4-5 hours.
- The third degree - edema and pain increase in an hour. The pain is strong, prolonged, the limb may turn blue.
Causes of hematomas
The main reason is soft tissue injury: severe bruises, bumps, squeezing, falling, stretching, pinching. In this case, blood vessels are damaged, blood spills out of them, which, with a large accumulation, cannot dissolve and accumulate in a certain place.
Another reason is blood pathology (leukemia, hemorrhagic vasculitis). Vascular rupture can also form after anticoagulants.
Non-mechanical reasons also include:
- Mallory-Weiss syndrome - cracks in the upper part of the stomach or lower esophagus, which arise due to straining during vomiting, after overeating or taking alcohol.
- Atherosclerosis - cholesterol plaques develop in the vessels and can lead to damage to the vessel.
- Hemorrhagic vasculitis - damage to the capillaries.
- Intramuscular hematoma - appears after intramuscular injection into the buttock.
- Postoperative hematomas - in pregnant women after cesarean section, which depends on vascular permeability and high blood pressure.
Classification of hematomas
Hematomas by type of hemorrhage are:
At the place of localization:
- under the skin;
- fascia;
- intermuscular.
At the clinic:
- limited;
- diffuse;
- throbbing
- osumkovany.
Hematoma in size and depth of damage is:
A mild hematoma develops within a day after an injury. The pain is slight, the movements are not disturbed. No swelling. Quickly resolves.
Medium - develops 3-5 hours after injury. The pain is more intense, the tissues are affected more deeply. The place of injury is swollen, sometimes interferes with movements.
Severe - formed within an hour after an impact. General and local temperature may increase, the pain is constant, severe, movements are limited.
According to the clinical manifestations of hematoma are divided into the following:
- Limited on the periphery - in such cases the edges are dense, softening in the center.
- Osumkovannye hematomas - inside the accumulation of a large amount of fluid. They are able to dissolve independently only with small sizes.
- Diffuse - tend to increase rapidly and require a quick opening.
According to the state of accumulated blood, hematomas are coagulated and non-coagulated (fresh), uninfected and infected with pus, throbbing and non-pulsating.
In appearance, hematomas are divided:
- on arterial - they have a bright red color and their area is larger;
- venous - cyanotic-violet;
- mixed - the most common.
By localization:
- subcutaneous
- submucous;
- intramuscular
- subfascial;
- subserous (usually in the abdominal cavity or in the lungs);
- retrochorial (in pregnant women);
- the most dangerous: in the brain and chronic hematomas.
If the traumatized hematoma does not resolve and its connective tissue membrane grows, a cyst forms. Such a hematoma is always to some extent elastic and changes its shape with a change in the position of the human body.
Symptoms of the constricted hematoma
The main symptom is a change in skin color in the area of ​​damage, first to crimson red, then burgundy, cyanotic, yellow-green. The overall clinical picture is determined by the severity of the hematoma.
If the traumatized hematoma is localized in the fiber of the skin, then it is manifested by bulging. Palpation is painful, the skin above it is slightly hyperemic.
Intramuscular location leads to swelling of the limbs, movements are limited and pain is more pronounced. For diagnosis, ultrasound or diagnostic puncture is used.
With small sizes, the clumped hematoma is able to dissolve itself, but more often it exists for a long time and during this time it can be saturated with calcium salts and thicken.
If the hematoma does not resolve, surgeon intervention is required. In the presence of abrasions, such a hematoma is often suppurated. Then it increases sharply in size, the temperature rises and an urgent operation is required.
If the tumor is not operated on time, complications arise.
First Aid Rules for Bruises
Treatment of an osmotic hematoma begins with the application of cold 2 times per hour for 5-10 minutes. If the blow was insignificant, polymedal (a special film to improve capillary blood flow) will help, then a hematoma does not form at all. This is true, in particular, for the face.
If the blow was serious, it is better to apply a tight bandage from an elastic bandage for 1-2 hours. You can bandage only the limbs. Heat can be used only on the third day. It is applied for 40 minutes 2 times a day.
You can take painkillers only if the hematoma is not in the abdominal cavity and not in the head area. The patient needs to ensure peace. Also on the 3rd day, you can start applying ointments and gels.
For facial injuries, the best ointment for bruises and bruises is "Bruise-OFF." Its composition includes leech extract. The ointment has not only an absorbable effect, but also a tonic. She has a pleasant smell, and there is no discomfort.
How long does the occluded hematoma resolve on the face? Usually within a week, but sometimes up to the 8th-9th days.
What is dangerous hematoma
With extensive hemorrhages in the cavity of the internal organs, after some time, the spilled blood begins to decompose with the breakdown of hemoglobin. Endotoxicosis occurs - the accumulation and poisoning of tissues by decay products.
A large hematoma on the leg, for example, can lead to such complications:
- chronic synovitis - inflammation of the synovial membrane of the joint, effusion begins to accumulate in the joint cavity;
- hemarthrosis - hemorrhage inside the joint.
And intracranial hemorrhages cause changes in the psyche: amnesia, impaired reaction and attention, increased anxiety, seizures, and personality changes.
Hematoma treatment
Small concocted hematomas can be treated conservatively. Applying cold to a fresh hematoma helps a lot.
The ointment is systematically applied. The best ointments for bruises and hematomas are Lyoton, Troxevasin-gel, Heparin Ointment, and Vishnevsky Ointment. Recently applied “Bruise-off”, balm “Rescuer”, cream-balm “SOS”, ointment “911”, “Mederma”. All of them have a resolving effect. In addition, they have a regenerating and stimulating metabolic effect.
The price of "Lioton" depends on the size of the tube. Useful are ointments that strengthen blood vessels: troxevasin, troxerutin.
NSAIDs ointments have anti-inflammatory, decongestant effects: Fastum Gel, Ketonal, Diclofenac, Voltaren Emulgel.
The price of "Lioton" is another of its advantages, it is low (from 340 rubles) and does not differ much in different regions. The peculiarity of the ointment is that it can be applied to exposed surfaces after damage.
Physiotherapy is also prescribed (solux, infrared or blue lamp, magnetotherapy, UHF, electrophoresis). After some time, the damaged area of ​​the skin begins to change color in the process of resorption.
In addition, the doctor may prescribe drugs to strengthen the walls of blood vessels: Ascorutin, Kapilar, Troxevasin2, Rutin, etc. Kapilar is especially good for the elderly.
Surgery
Large, festering and swelling or pulsating, clotted hematomas should be treated only by opening under local anesthesia. More often it concerns intermuscular hematomas. Through the cut, the contents are squeezed out. And the cavity is then treated with peroxide. A tight bandage is applied.
In some cases, during surgery to remove the hematoma with damage to large vessels, the surgeon finds a damaged vessel and bandages it.
When infected with a hematoma, a cavity with pus forms. The procedure for opening the popped-up hematoma, in this case, is also indicated for extensive hematomas. The surgeon performs an autopsy of such a cavity, rinses it with antiseptics and puts drainage to drain the accumulated fluid. Next, an antiseptic dressing is applied and antibiotics are prescribed. More often this occurs with abdominal hematomas. Sutures are removed after 10 days. All this time, the patient takes antibiotics.
A later complication of the hematoma is its organization. This refers to impregnation with calcium salts to form a capsule. Such a capsule is also excised.
A hematoma after falling with a bruise on the abdomen, head and chest needs to be consulted by a doctor immediately, since there is a possibility of damage to internal organs or the brain. With intracranial hematomas, conservative treatment is possible with a hematoma volume of up to 40 ml and the absence of brain symptoms. Otherwise, craniotomy is performed. A bone flap is cut out, an aspirator removes blood from the hematoma, the cavity is washed, the bone flap returns and the tissue is sutured in the reverse order.
Forecast
Usually, doctors give a good prognosis for soft tissue injuries. The worst prognosis can be obtained with head injury with an epidural or subdural hematoma. With severe damage, the resorption process is delayed for several years.
Preventive measures
Preventive measures are caution, minimizing injuries, and eliminating infection. In a house with young children, the number of sharp corners should be minimized. When doing cycling or rollerblading and skating, you need to use knee pads, elbow covers and a helmet. Before each workout, it is important to warm up.