Managing a haematoma on your leg with dressings (conservative management)

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What is this information about?

This information is about what will happen to you if you have a haematoma on your leg. A haematoma is a collection of blood under the skin.

It tells you:

• how a haematoma is caused
• how it can be managed without surgery (conservative management)
• what the plastic surgery nurses will do to help you
• how you can look after yourself at home.

It also tells you how you can avoid haematomas in the future.

Why have I been given this information?

You have been given this information because you have, or are at risk of getting, a haematoma.

If you read this information and follow the advice here, you will have a better understanding of how your haematoma is treated, and what you can do to help yourself heal.

What is a lower limb (leg) haematoma?

A haematoma is a collection of blood under the skin. Haematomas are usually caused by a bump or fall that causes injury to a blood vessel.

The haematoma may look like a large bruise and can be swollen and painful. The blood forms a bump under the skin and there may be dark area where the skin was impacted.

Older adults are more at risk because of:

• skin changes
• reduced circulation
• medication such as blood thinners.

It may look like the picture below:

What should I do if I have a haematoma?

If you think you have a haematoma you should seek medical advice.

It is important that the swelling and bleeding is controlled.

If the haematoma is bleeding, you may need to go to A&E to have the bleeding controlled. The emergency team will stop the bleeding. You can help to slow the bleeding by elevating (lifting) your leg or putting pressure on the wound.

The emergency team will then refer you to the most appropriate team in the hospital to help you get better.

If the haematoma is not bleeding but is swelling, you still need to seek medical advice. Your GP surgery or a minor injuries unit may be able to help you.

How is the haematoma removed?

Once the haematoma has stopped bleeding the trapped blood forms a lump or ‘clot’. Some of the trapped blood will be gradually broken down and absorbed by the body.

Not all haematomas need surgery. Sometimes larger haematomas need some help from specialised dressings (bandages) to break down. This is called ‘conservative’ or non-surgical management.

Your plastics specialist nurses will use special dressings designed to soften the haematoma. The plastics specialist nurses may remove some dead skin as dead skin can feed bacteria. This is called ‘debridement’.

Once it has softened, the haematoma may then be released with some gentle pressure. This process is gradual and takes a few weeks.

Why is conservative management a good option?

Conservative management is good because:

• you can avoid having an anaesthetic for an operation if it is too risky
• you do not have to stay in hospital, and you can be cared for at home
• you have more choice and options for your treatment.

Most haematomas can heal successfully without surgery with the right care.

What dressings will be used?

The dressings will be selected by the plastics specialist nurses. Each person’s wound is different and may need different types of dressings to help it heal. As the wound heals it changes so different dressings will be used to support this.

Sometimes when the haematoma softens it can leak. This is normal and super-absorbent dressings will be used to keep any leaking under control. This is the old blood breaking down. It may appear darker or a brownish colour. It may also have a metallic smell.

What will my dressings look like?

The plastics specialist nurses will apply a well-padded, supportive bandage that starts from the toes and ends at your knee. This is to reduce swelling, help the blood supply and protect the leg.

You may need to wear loose or sized-up shoes as sometimes the bandage makes it difficult to put your regular shoes on.

The bandage will look similar to the image below.

How long will my haematoma take to heal?

Every person and every haematoma is different so it is difficult to say how long each one will take to heal.

Your plastic surgery nurses will see you regularly for a dressing review. They will give you an update on how your wound is healing then.

What can I do to help my haematoma heal at home?

• Elevate (raise) your leg when sitting or lying down.
• Keep compression bandages in place.
• Keep the dressing clean and dry.
• Eat well and stay hydrated (have enough to drink) to support healing.
• If you wish to shower, use a waterproof shower protection sock. For details speak to your plastic surgery nurses.

How can I prevent haematomas from happening in the future?

Your plastic surgery nurses can give you detailed information about how to stop haematomas happening in the future.

To reduce the risk of future haematomas you can:

• Use an emollient to moisturise your skin daily to keep it healthy.
• Wear protective clothing (such as long trousers) to prevent injuries.
• Follow medical advice if you take blood thinners.
• Use supportive stockings if you have been prescribed them.

Who can I contact for further information and advice?

If you or your loved ones have any further concerns or queries, please do not hesitate to contact the plastic surgery team.