Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Management of Chronic Expanding Haematoma Using Triamcinolone after Latissimus Dorsi Flap Harvesting

  • Hamada, Mariko (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Shimizu, Yusuke (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Aramaki-Hattori, Noriko (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Kato, Tatsuya (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Takada, Keiko (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Aoki, Marie (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Kishi, Kazuo (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Nagasao, Tomohisa (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine)
  • Received : 2014.07.24
  • Accepted : 2014.11.03
  • Published : 2015.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Chronic expanding haematoma (CEH) is a rare type of haematoma that enlarges slowly and continuously without coagulation. It can occur following surgery because of shear stress-induced bleeding in the scar tissue between the subcutaneous fat and fascia. We present three cases of large chronic CEH that were successfully treated with triamcinolone injections. Three female patients developed large chronic CEH at 9 months, 5 years, and 6 years, respectively, after latissimus dorsi flap harvesting for breast reconstruction. Although the condition did not improve after multiple sessions of haematoma aspiration in the first two patients, it resolved following a single 40-mg triamcinolone injection along with appropriate compression dressing for several weeks. In the third patient, triamcinolone was injected immediately after the initial aspiration of the haematoma, and the condition improved considerably. There were no side effects in any of the patients. To the best of our knowledge, this is the first report of successful treatment of large CEH using triamcinolone. Therefore, we suggest that triamcinolone injections be considered for the treatment of CEH.

Keywords

References

  1. Yamamoto S, Momose T, Aoyagi M, et al. Spontaneous intracerebral hematomas expanding during the early stages of hemorrhage without rebleeding. Report of three cases. J Neurosurg 2002;97:455-60. https://doi.org/10.3171/jns.2002.97.2.0455
  2. Bradshaw JR, Davies GT, Edwards PW, et al. The radiological demonstration of traumatic cysts due to severe soft tissue trauma. Br J Radiol 1972;45:905-10. https://doi.org/10.1259/0007-1285-45-540-905
  3. Sterling A, Butterfield WC, Bonner R Jr, et al. Post-traumatic cysts of soft tissue. J Trauma 1977;17:392-6. https://doi.org/10.1097/00005373-197705000-00012
  4. Labadie EL, Glover D. Physiopathogenesis of subdural hematomas. Part 1: Histological and biochemical comparisons of subcutaneous hematoma in rats with subdural hematoma in man. J Neurosurg 1976;45:382-92. https://doi.org/10.3171/jns.1976.45.4.0382
  5. Watanabe K, Morihisa Y, Gotanda K, et al. A case of a chronic expanding hematoma that developed in a latissimus dorsi muscle flap donor site. J Plast Reconstr Aesthet Surg 2013; 66:872-4. https://doi.org/10.1016/j.bjps.2012.11.043
  6. Goddard MS, Vakil JJ, McCarthy EF, et al. Chronic expanding hematoma of the lateral thigh and massive bony destruction after a failed total hip arthroplasty. J Arthroplasty 2011;26:338.e13-5.
  7. Sreenivas M, Nihal A, Ettles DF. Chronic haematoma or soft-tissue neoplasm? A diagnostic dilemma. Arch Orthop Trauma Surg 2004;124:495-7.
  8. Kitagawa Y, Yokoyama M, Tamai K, et al. Chronic expanding hematoma extending over multiple gluteal muscles associated with piriformis syndrome. J Nippon Med Sch 2012;79:478-83. https://doi.org/10.1272/jnms.79.478
  9. Sakurai J, Akaki S, Yonezawa M, et al. Intrapelvic chronic expanding hematoma: magnetic resonance imaging findings with pathological correlation. Magn Reson Med Sci 2010;9:81-4. https://doi.org/10.2463/mrms.9.81
  10. Daw JL, Lewis VL, Smith JW. Chronic expanding hematoma within a periprosthetic breast capsule. Plast Reconstr Surg 1996;97:1469-72. https://doi.org/10.1097/00006534-199606000-00026
  11. Lewis VL Jr, Johnson PE. Chronic expanding hematoma. Plast Reconstr Surg 1987;79:465-7. https://doi.org/10.1097/00006534-198703000-00030
  12. Sugaya F, Kitazawa T, Fukuda C, et al. Chronic expanding haematoma of the latissimus dorsi muscle flap donor site: a case report. Jpn J Plast Surg 2008;51:1205-11.
  13. Pulcinelli FM, Riondino S, Celestini A, et al. Persistent production of platelet thromboxane A2 in patients chronically treated with aspirin. J Thromb Haemost 2005;3:2784-9. https://doi.org/10.1111/j.1538-7836.2005.01633.x
  14. Satoh K, Yatomi Y, Ozaki Y. A new method for assessment of an anti-5HT(2A) agent, sarpogrelate hydrochloride, on platelet aggregation. J Thromb Haemost 2006;4:479-81. https://doi.org/10.1111/j.1538-7836.2006.01757.x
  15. Taghizadeh R, Shoaib T, Hart AM, et al. Triamcinolone reduces seroma re-accumulation in the extended latissimus dorsi donor site. J Plast Reconstr Aesthet Surg 2008;61:636-42. https://doi.org/10.1016/j.bjps.2007.03.019

Cited by

  1. Ultrasound-guided procedures to treat sport-related muscle injuries vol.89, pp.1057, 2015, https://doi.org/10.1259/bjr.20150484
  2. Treatment of late solidified hematoma in back donor site after breast reconstruction with latissimus dorsi flap: report of three cases vol.19, pp.None, 2019, https://doi.org/10.1186/s12893-019-0516-6