The feasibility of ultrasound-guided vacuum-assisted evacuation of large breast hematomas

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_raon-2020-0041_s_005_w2aab3b7ab1b6b1aab1c12b1Aa"><jats:title>Background</jats:title><jats:p>Breast hematoma is an often underrated and disregarded post-procedural complication in the literature. Current treatment modalities are comprised of either surgical or expectant therapy, while percutaneous procedures play a smaller role in their treatment. We aimed to examine the efficacy of vacuum-assisted evacuation (VAE) in the treatment of clinically significant large breast hematomas as an alternative to surgery.</jats:p></jats:sec><jats:sec id="j_raon-2020-0041_s_006_w2aab3b7ab1b6b1aab1c12b2Aa"><jats:title>Patients and methods</jats:title><jats:p>We retrospectively analysed patients that underwent breast interventions (surgical and percutaneous), who later developed clinically significant large hematomas and underwent a trial of VAE of hematoma in our hospital within the period of four years. Patient and procedure characteristics were acquired before and after VAE. Success of intervention was based on ≥ 50% clearance of hematoma volume and patients’ subjective resolution of symptoms. All patients were followed clinically and by ultrasound if needed at different intervals depending on the severity of presenting symptoms.</jats:p></jats:sec><jats:sec id="j_raon-2020-0041_s_007_w2aab3b7ab1b6b1aab1c12b3Aa"><jats:title>Results</jats:title><jats:p>Eleven patients were included in the study. The mean largest diameter of hematomas was 7.9 cm and mean surface area was 32.4 cm<jats:sup>2</jats:sup>. The mean duration of the procedure was 40.5 min. In all patients VAE of hematoma was implemented successfully with no complications. Control visits showed no major residual hematoma or seroma formation.</jats:p></jats:sec><jats:sec id="j_raon-2020-0041_s_008_w2aab3b7ab1b6b1aab1c12b4Aa"><jats:title>Conclusions</jats:title><jats:p>Our results show that VAE of hematoma can be implemented as a safe alternative to surgery in large, clinically significant hematomas, regardless of aetiology or duration. The procedure carries less risk, stress and cost with the added benefit of outpatient treatment when compared to surgical treatment.</jats:p></jats:sec>

Applications of Ultrasound in the Postoperative Period: A Review

“…Indications for return to the operating room for evacuation of the hematoma include rapidly expanding size, threatened flap, hematomas in the head and neck that may compromise the airway, and hemodynamic instability. 24 26 28 Smaller, more stable hematomas may be amenable to evacuation at bedside. Historically, hematomas were evacuated surgically by reopening the surgical incision or making a small incision superior to the hematoma, and utilizing pressure, irrigation, and suction to evacuate the clot.…”

“…A 2020 study by Almasarweh et al found that ultrasound-guided vacuum-assisted evacuation of breast hematomas was a safe alternative to surgical evacuation, and was able to be performed effectively between days 1 and 597 postoperatively. 28…”