The mechanism of occurrence of hematomas and the etiology of the preceding processes are closely related. Encapsulated hematoma in this case is no exception. In order to understand the causes of its occurrence and learn about the methods of treatment, you need to familiarize yourself with the following information.
A bit of anatomy
The skin has 3 layers with their own special properties: epidermis, dermis, hypodermis (subcutaneous fat layer).
The epidermis is the topmost and thinnest layer, there are no blood vessels in it and only a few layers of cells. It feeds on the diffusion of substances from the lower deep layers of the skin. With closed injuries, it remains intact. Its function is protective.
The dermis, or the actual skin, is connective tissue fibers. There are already some nerve endings and vessels in the form of capillaries. The dermis plays a role in the appearance of subcutaneous hematomas, but there is practically no hemorrhage here. This is due to the fact that the connectingthe fibers are built tightly and there is no place for blood cavities to form here. Nerve endings react to pain in case of injury.
Subcutaneous fat is the deepest layer. Built in the form of cells containing areas of fat, separated by connective tissue septa.
Nutrients and small vessels are concentrated here. In the areas there is a deposition of nutrition or there is a flow, if necessary. Hematomas form here because the adipose tissue is softer and easily pulled apart for cavities. Blood is also poured here when larger vessels are damaged.
Separation of concepts
When the skin is damaged, intra- or subcutaneous hemorrhages can occur, which are called differently, often considering them an analogy. But they are all different. The injury is also called a bruise, and a hematoma, and a bump, but these are not synonyms. For example, a hematoma and a bruise: they only have a common cause - external or internal influence or disease. But with a hematoma, there is necessarily a cavity where blood has poured out and the tissue structure is damaged. It appears due to the delamination of the fabric.
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, according to localization, they distinguish:
- epidural (extradural) hematoma - between the bones of the skull and the dura mater;
- subdural hematoma (under the dura mater);
- subarachnoid hematoma (under pia mater);
- intracerebral, orparenchymal in the substance of the brain, subcutaneous hemorrhage on the head is often called a bump - in adults.
Bruising is also a hemorrhage into soft tissues, but the structure is not broken here, and a cavity does not appear. Colloquially, it is called a bruise.
Bruising is only a colloquial term, not a medical one. It is not used in official documents. Some people like to flash medical terminology and call a bruise a hematoma, although this is fundamentally wrong. To be precise, this is hemorrhagic impregnation of the skin.
Why is it so important to separate these concepts? Because they have different consequences, treatment and severity. The degree of injury may determine the appearance of a bruise or hematoma.
Degrees of bruises
Bruises are 3 degrees. At the 1st degree, there will be only a bruise, which will resolve itself and is not dangerous. Other degrees lead to the appearance of hematomas. Hematomas are unpredictable, do not disappear on their own, can be complicated and require treatment. They can also occur without injury, when the vessel spontaneously ruptures - this is a spontaneous hematoma. The skin at the site of injury goes through all stages of color change: red, red-blue or yellowish-green.
- The first degree of bruising is a small bruise. Becomes noticeable the next day. It hurts a little and there is no swelling here.
- Second degree - the pain appears immediately and the impact site swells. The bruise occurs within 4-5 hours.
- Third degree - swelling and pain increase in an hour. The pain is severe, prolonged, the limb may turn blue.
Reasons for appearancehematoma
The main reason is soft tissue injury: severe bruises, blows, squeezing, falling, stretching, pinching. In this case, the vessels are damaged, blood is poured out of them, which, with a large accumulation, cannot be absorbed and accumulates in a certain place.
Another reason is blood pathologies (leukemia, hemorrhagic vasculitis). Rupture of blood vessels can also occur after anticoagulants.
Non-mechanical causes also include:
- Mallory-Weiss syndrome - cracks in the upper stomach or lower esophagus that occur due to straining when vomiting, after overeating or drinking alcohol.
- Atherosclerosis - cholesterol plaques develop in the vessels and can lead to damage to the vessel.
- Hemorrhagic vasculitis - capillary damage.
- Intramuscular hematoma - appears after intramuscular injections in the buttock.
- Postoperative hematomas - in pregnant women after caesarean section, which depends on vascular permeability and high blood pressure.
Classification of hematomas
Hematomas by type of hemorrhage are:
- arterial;
- venous;
- mixed.
According to location:
- under the skin;
- fascia;
- intermuscular.
At the clinic:
- limited;
- diffuse;
- pulsing;
- bagged.
Hematoma by size and depth of damagehappens:
- light;
- medium;
- heavy.
Slight hematoma develops within a day after the injury. The pain is insignificant, the movements are not disturbed. There is no swelling. Absorbs quickly.
Medium - develops 3-5 hours after injury. The pain is more intense, the tissues are affected more deeply. The site of the injury swells up and sometimes interferes with movement.
Heavy - formed within an hour of impact. The general and local temperature may rise, the pain is constant, severe, the movements are limited.
By clinical manifestations, hematomas are divided into the following:
- Limited on the periphery - in such cases, the edges are dense, softening in the center.
- Encapsulated hematomas - inside the accumulation of a large amount of fluid. They can dissolve on their own only at small sizes.
- Diffuse - tend to grow rapidly and require quick opening.
According to the state of accumulated blood, hematomas are clotted and not clotted (fresh), uninfected and infected with pus, pulsating and non-pulsating.
By appearance, hematomas are divided:
- on arterial - have a bright red color and their area is larger;
- venous - cyanotic purple;
- mixed - the most common.
By localization:
- subcutaneous;
- submucosal;
- intramuscular;
- subfascial;
- subserous (usually in the abdomen or lungs);
- retrochorial (in pregnant women);
- the most dangerous: in the brain andold hematomas.
If the encysted hematoma does not resolve and its connective tissue sheath grows, a cyst is formed. Such a hematoma is always elastic to some extent and changes its shape when the position of the human body changes.
Symptoms of encysted 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 encysted hematoma is localized in the skin tissue, then it is manifested by swelling. It is painful on palpation, the skin above it is slightly hyperemic.
Intermuscular location leads to swelling of the limb, movement is limited and pain is more pronounced. For diagnosis, ultrasound or diagnostic puncture is used.
At a small size, an encysted hematoma is able to resolve itself, but more often it exists for a long time and during this time it can become saturated with calcium s alts and thicken.
If the hematoma does not resolve, surgical intervention is required. In the presence of abrasions, such a hematoma often suppurates. Then it sharply increases in size, the temperature rises and an urgent operation is required.
If the tumor is not operated on in time, complications arise.
First aid rules for bruises
Treatment of encysted hematoma begins with applying cold 2 times within an hour for 5-10 minutes. If the blow was insignificant, polimedel will help (a special film forimprove capillary blood flow), then the hematoma does not form at all. This is true, in particular, for the face.
If the blow was severe, it is better to apply a tight elastic bandage for 1-2 hours. You can only bandage the limbs. Heat can be used only on the third day. It is applied for 40 minutes 2 times a day.
Take painkillers only if the hematoma is not in the abdominal cavity and not in the head area. The patient needs to be kept calm. Also on the 3rd day, you can start applying ointments and gels.
In case of facial injuries, the best ointment for bruises and hematomas is "Bruise-OFF". It contains leech extract. The ointment has not only a resolving effect, but also a tonic. She has a pleasant smell, and there is no discomfort.
How long does an encysted hematoma on the face resolve? Usually within a week, but sometimes up to 8-9 days.
What is dangerous hematoma
With extensive hemorrhages in the cavity of internal organs, after a while the outflowing blood begins to decompose with the breakdown of hemoglobin. There is endotoxicosis - the accumulation and poisoning of tissues by decay products.
A large hematoma on the leg, for example, can lead to the following 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, increasedanxiety, seizures, personality changes.
Hematoma treatment
Small encysted hematomas can be treated conservatively. Applying cold to a fresh hematoma helps well.
The ointment is systematically applied. The best ointments for bruises and hematomas are Lyoton, Troxevasin-gel, Heparin ointment and Vishnevsky ointment. Recently, "Bruise-off", "Rescuer" balm, "SOS" cream-balm, "911" ointment, "Mederma" have been used. All of them have a resolving effect. In addition, they have a regenerating and metabolic stimulating effect.
The price of Lyoton depends on the size of the tube. Ointments that strengthen blood vessels are useful: troxevasin, troxerutin.
NSAID ointments have anti-inflammatory, decongestant effects: Fastum-gel, Ketonal, Diclofenac, Voltaren emulgel.
The price of Lyoton 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 open 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, Capilar, Troxevasin2, Rutin, etc. Capilar is especially good forelderly.
Surgical treatment
Large, festering and bulging or pulsating encysted hematomas should only be treated by opening under local anesthesia. More often it concerns intermuscular hematomas. Through the incision, the contents are squeezed out. And the cavity is then treated with peroxide. A tight bandage is applied.
In some cases, during an operation to remove a hematoma with damage to large vessels, the surgeon finds the damaged vessel and bandages it.
When infected with hematomas, a cavity with pus is formed. The procedure for opening an encysted hematoma, in this case, is also indicated for extensive hematomas. The surgeon opens such a cavity, rinses it with antiseptics and puts a drain to drain the accumulated fluid. Next, an antiseptic dressing is applied and antibiotics are prescribed. Most often this occurs with hematomas of the abdominal cavity. The stitches are removed after 10 days. All this time the patient is taking antibiotics.
A later complication of hematoma is its organization. This refers to impregnation with calcium s alts with the formation of a capsule. Such a capsule is also excised.
Hematoma after a fall with a bruise of the abdomen, head and chest needs to be consulted by a doctor immediately, as 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, a trepanation of the skull is performed. A bone flap is cut out, with the help of an aspirator, blood is removed from the hematoma, the cavityis washed, the bone flap is returned and the tissues are sutured in reverse order.
Forecast
Usually, doctors give a good prognosis for soft tissue injuries. The worst prognosis can be obtained with TBI with epidural or subdural hematoma. With severe injuries, the resorption process is delayed for several years.
Prevention measures
Preventive measures are caution, minimization of injuries, exclusion of infection. In a home with young children, the number of sharp corners should be kept as low as possible. When cycling or rollerblading or skating, knee pads, elbow covers and a helmet must be worn. It is important to warm up before every workout.
