Reducing Hematomas While Improving Bruise ResolutionLaura Barnes RN, MSN, CWCN, CCNS, APN, FNP, Edward-Elmhurst Health, Elmhurst Outpatient Wound Care Clinic, Elmhurst, Illinois.

ProblemHematomas are caused by accumulation of blood resulting from bleeding into the tissues. This often occurs with trauma, anticoagulation therapy or surgically induced tissue injury. Hematomas can apply pressure on tissues causing ischemia, contribute to risk of dehiscence, be a nutrient source for infectious organisms and slow wound healing by prolonging inflammation and expanding the zone of secondary injury. 7 patients are being presented with hematomas or bruising associated with open wounds or closed tissue injuries.

• Patient 1, mid 30’s female: Puppy scratch on upper thigh.• Patient 2, 71 year old female: Patient fell and sustained knee/ lower leg trauma with large deep tissue hematoma, edema and discomfort • Patient 3, middle age female: Surgical excision of an abnormal mole on posterior thigh experiencing extreme pain. Patient wound care orders were to remove absorbent pad after 24 hours and apply petroleum jelly daily• Patient 4, 54 year old : Tibial fracture complicated by compartment syndrome after a ski accident with hematoma. There were visible signs of infection over the knee and swelling/tension caused post-operative blistering areas.• Patient 5, 79 year old female: Total knee replacement with swelling and a huge hematoma on her thigh due to a punctured vein as a result of a post-op pain catheter• Patient 6, college student : Calf athletic injury contusion with ecchymosis/ hematoma and pain. The patient had been treated with cold, ultrasound, soft- tissue massage and light therapy for 14 days with little resolution.• Patient 7, 17 year old: Knee athletic injury; undetermined cause. The patient had arthroscopic surgery for discoid lateral meniscus with limited range of motion, bruising, persistent severe edema and pain. Patient was given oral pain medication but continued to have severe pain.

RationalePolymeric Membrane Dressings* (PMDs) help control inflammation. They reduce secondary cell damage and pain caused by both swelling and bruising. PMDs help to reduce pain by reducing the secondary cell damage by reducing the recruitment of adjacent inflammatory nerve endings- the nociceptors. The reduction of swelling and secondary injury reduces wound sensitivity to touch and manipulation during dressing changes. PMDs help by not adhering to the wound. This reduces wound bed pain and trauma with dressing removal. The cleansing system helps to loosen debris and necrotic tissue, facilitating autolytic debridement. PMDs absorb up to 10 times their weight in exudate, optimizing moisture balance and helping prevent maceration.

MethodsTo prevent complications, polymeric membrane dressings (PMDs) were initiated: 1). with and without silver, 2). non-sterile PMD wraps, 3). with and without adhesive border. PMDs were applied per manufacturer instructions and the change schedule ranged from every 2 to 3 days to once a week, and as needed.

ResultsMajor hematoma reduction and the visual signs of bruising were also reduced with implementation of PMDs for all patients. In addition, there was a decrease in swelling, inflammation and pain. No wound dehiscence developed. For patient 3, severe pain was reduced within an hour of applying PMD. For patient 4, 2 days after the application of PMDs, there was a decrease in tension and a change of color of the hematoma so the patient could begin their physiotherapy. After 5 days of PMD application, signs of infection decreased. For patient 6, after 24 hours, there was a dramatic reduction in ecchymosis and point tenderness. For patient 7, during first 2 days of PMD application, edema and pain were considerably reduced and range of motion improved significantly. All patients had resolution of their injury faster than the clinicians anticipated based on the type of injury they were treating. The dressings were easy to apply and change. Polymeric membrane dressings enhance the possibility of full recovery for the athlete and non-athlete.

ConclusionsPMDs helped: 1) resolve the hematomas for open and closed tissue injuries 2) heal the incision sites with no complications. Resolution resulted in faster recovery for the patients and quicker return to daily activities.

*PolyMem® Dressings, PolyMem Silver®, PolyMem SportsWrap®, PolyMem Shapes, PolyMem® Film Island Dressings Ferris Mfg. Corp.,5133 Northeast Parkway, Fort Worth, TX 76106-1822 USA, 1-800.POLYMEM (765.9636) www.polymem.com

This case study was unsponsored. Ferris Mfg. contributed to this poster presentation.

Bibliography

1. Bryant R, Nix D. Acute & Chronic Wounds. Current Management Concepts. 4th ed. St. Louis, MO: Mosby; 2012.

2. Burkhard R. Efficient reduction of swelling and bruising on severe sports injuries when using polymeric membrane dressings. Poster presented at European Wound Management Association (EWMA) Meeting, Poster #P218, May 26-28, 2010. Geneva, Switzerland.

4. Doughty D. Preventing and managing surgical wound dehiscence. Home Healthcare Nurse. 2004; 22(6):364-367.

5. Franz MG, Robson MC, Steed DL, Barbul A, Brem H, Cooper DM, Leaper D, Milner SM, Payne WG, Wachtel TL, Wiersema- Bryant L. Guidelines to aid healing of acute wounds by decreasing impediments of healing. Wound Rep Reg. 2008; 16: 723-748.

6. Geffen A. Managing inflammation by means of polymeric membrane dressings in pressure ulcer prevention. Wounds International. 2018; 9(1): 22-28.

7. Harrison J. Wounds with limb threatening hematomas and necrosis successfully managed with polymeric membrane dressings. Poster presented at 2010 WOCN/WCET Joint Conference, Poster #4537, June 13-16, 2010. Phoenix, Arizona.

8. Schlotfeldt R. Utilization of SPORTSWRAP® by PolyMem® in the treatment of blunt trauma injury. Ferris Mfg. Corp. Fort Worth, Texas 76106.

9. Sessions R. Chronic knee pain inn high school athlete with discoid meniscus. Poster presented at 57th Annual National Athletic Trainers Association (NATA) Meeting & Clinical Symposia, Poster #6053, June 14-18, 2006. Atlanta, Georgia.

10. Starkey C. Therapeutic Modalities.4th edition. Philadelphia, PA: F.A. Davis Company; 2013.

Patient 1

Day 0Puppy scratch experienced after the patient was playing with her dog.

One of the dog nails hooked on to her leg and scratched her thigh.

Day 0; PMD Day 0PMD applied immediately after the scratch, as patient bruises very easily. Placed in the middle of the scratch to see how PMD would heal.

PMD Day 2 Bruising resolving where PMD applied.PMD removed after 48 hours!

PMD Day 0PMD non-sterile wrap applied.11 days post-arthroscopic surgery for discoid lateral meniscus.The patient had severe persistent edema and pain accompanied by moderate bruising.

PMD Day 617 days post-op, a considerable reduction of pain, edema, bruising. Range of motion improved significantly.

Patient 7

Patient 3

Post-Op Day 2; PMD Day 1

Persistent pain is now 1 (0-10 scale), 24 hrs. after PMD application. Patient is amazed areas of bruising are fading where PMD was applied.Larger PMD dressing was applied at this change, in order to cover all the bruise.

Post-op Day 6; PMD Day 7No pain and bruising is resolving.The bruise spreading due to incisional depth /trauma from procedure and walking.

Post-op Day 18; PMD Day 1717 days after initial application of PMD

Sutures removed 16 days post- procedure and 15 days after initial application of PMD.

5 PMDs were used until closure and bruise resolution.

Operative DayNurse Practitioner in Dermatology applied extra absorbent pad which patient was to remove 24 hours post-procedure.

Post-Op Day 1; PMD Day 0At 24 hrs. post-procedure, patient was in extreme pain. Pain 8 (0-10 scale). Based on patient’s previous use of PMDs, patient was anxious to have PMD dressing applied in order to reduce severe pain. The site was inaccessible to the patient, so her spouse put the dressings on and took the photos in this series.

After application, pain decreased within 1 hour.

PMD Day 81

Photo 81 days after the initial application of PMDs.Wound closed one week later.

PMD Day 0

Knee/ lower leg traumaPrior care: triple antibiotic covered with gauze and wrapped in stretch gauze over the sutures.80% necrotic tissue.9.0 cm x 5.0 cm x 4.0 cm deep wound with 4.0 cm of undermining along with deep tissue hematoma.PMD silver rope inserted into wound tunnel.The silver rope cavity filler was covered with PMD with or without silver. Result, rapid liquification of the hematoma.

Patient 2

Polymeric Membrane Dressings • Control Inflammation • Reduce both persistent and procedural wound Pain • Increase Healing