Bedside treatment of early acute rhytidectomy hematomas

Hematoma remains the most common major complication following rhytidectomy. Large expanding hematomas can result in partial flap loss, infection, hyperpigmentation, subcutaneous nodules, skin puckering, scar contraction, excessive facial edema, and prolonged convalescence. Numerous methods designed to minimize postrhytidectomy hematomas such as hypotensive anesthesia, "second look," fibrin glue, suction drains, and dressings have been used, yet the incidence has remained fairly constant over the past 20 years. With greater awareness of blood pressure control and diligent perioperative blood pressure medical management, expanding hematomas that usually require operating room drainage can be managed at the patient bedside with early diagnosis and treatment. A simplified approach to bedside management of early acute rhytidectomy hematomas that has been used since 1990 is described. Hypertension and anxiety must be controlled before and after bedside suction evacuation and irrigation. This method has avoided return to the operation room in the majority of cases.