“Pocket of blood on leg:” hematomas in chronic venous insufficiency

Sometimes hematomas are not impressive:

Screen Shot 2015-09-01 at 5.39.03 PMAnd then sometimes they look like this:

Screen Shot 2015-09-01 at 5.45.42 PMAnd then what do you do?!

Hematomas can occur in chronic venous insufficiency because of defective connective tissue, incompetent vein valves, and trauma to the area (even bumping the leg can do it!). Complications can include ulceration, although this can be avoided with wound care. Infection is unlikely unless the hematoma is super-deep.

People at risk for more severe hematomas are those on anticoagulation or the elderly.

How should you treat chronic venous insufficiency?

  • Educate the patient: the hematoma will likely be there for 1-2 weeks. It may drain on its own (aka, bleed all over). If this happens, don’t peel back the skin. Just clean it up with towels and let it be. This will improve healing.
  • Conservative management: use warm compresses 2-3x/day. This will help the blood resorb.
  • Advanced therapies like vein stripping, sclerotherapy, and radio frequency ablation are options, but might not be best in your very elderly (85+) patients.

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