Haematoma - Donkey
Definition: the accumulation of free blood under the skin. |
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Haematomas are quite common as a result of a direct blow such as a kick. In the early stages the swelling may seem to be firm, but it soon becomes apparent that it is fluid-filled. Pain may be only slight and even palpation may not be resented.
Haematoma can be differentiated from oedema or inflammatory fluid by the finger press test (In the case of oedema, a finger pressed onto the swelling and then removed will leave an indent that remains visible for some minutes. If the swelling is inflammatory there will probably be no pitting with pressure and in the case of haematoma the indentation will disappear immediately the finger is removed). Recurrent haematoma following minor trauma should alert the clinician to the possibility of blood-clotting disorders. Diagnosis can also be confirmed by a combination of ultrasonography, when the fluid nature of the swelling will be appreciated, and by aspiration. Haematomas that have been present for some days to weeks show separation of plasma/serum and clotted blood. The clot will tend to organize and become ultrasonographically denser. At this stage the overlying skin may crinkle slightly or may simply be ‘baggy’.
Management of haematoma is simple according to clinical preference. A haematoma can be drained, although there are risks associated with this, such as continued haemorrhage or infection. Alternatively, it can be left to organize. There are no definitive rules, but attempts to drain a haematoma should not be made too early because the risk of continued haemorrhage is higher.
In the early stages, direct pressure via a firm bandage may limit the size and speed up the organization phase, but in some locations it can be difficult or even impossible. A stent applied over the site may be sufficient to limit the size. Avoidance of any further trauma is important. Direct pressure to the drained area is sometimes helpful, but can also be difficult in some locations.
A scar may be visible as distorted skin, firmly bound down to the underlying tissues. Organizing haematomas in some sites, for example a penile haematoma, can result in penile deviations, while a haematoma within the semimembranosus-semitendinosus region may cause fibrotic myopathy. Haematomas that occur within the muscle sheath are particularly painful and can result in long-term fibrous metaplasia of the muscle belly with consequent loss of function.
References
- Knottenbelt, D. (2008) The principles and practice of wound mamagement In Svendsen, E.D., Duncan, J. and Hadrill, D. (2008) The Professional Handbook of the Donkey, 4th edition, Whittet Books, Chapter 9
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