Wound bleeding after head and neck surgery

Abstract

Using our head and neck service database, we reviewed 3,200 surgical procedures performed at our institution over a 7-year period. We identified 54 patients whose surgery was complicated postoperatively by wound bleeding. The procedure most often complicated by wound bleeding was parotidectomy, 1.7% (14 of 510 patients), followed by thyroidectomy, 1.6% (8 of 504 patients), neck dissection combined with other procedures, 1.3% (12 of 885 patients), and neck dissection alone, 1.1% (6 of 534 patients). Bleeding developed in flap donor sites in 2 of 227 patients and followed miscellaneous procedures in 12 others. Thirty-one patients were treated by reexploration in the operating room, 13 had limited exploration on the ward and 10 were observed with no intervention. There was no difference in wound healing between the three treatment groups. However, mean hospital stay was shortest for patients who had wound exploration in the operating room, 6.2 days, for exploration on the ward, 10.8 days, and 18.9 for those that were observed. Drains had no effect on wound healing or mean hospital stay.

Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

“…Previous studies established that the greatest risk of respiratory failure caused by hematoma occurs during the first 6 h after thyroid surgery and this result disencourages the discharging of the patients on the day of the operation (Hurtado-López et al, 2001;Matory and Spiro, 1993;Shaha and Jaffe, 1994). In the present study, developed two hematomas were minimal and possibly developed over a long time.…”

“…Many surgeons routinely use drains after thyroidectomy. The main reason is to drain off a possible postoperative haemorrhage, which may compress the air passages and produce respiratory failure (Matory and Spiro, 1993;Shaha and Jaffe, 1993). Haemorrhage might be life-threatening and require immediate re-operation.…”

Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting

“…4 Avoidance of postoperative vomiting has, therefore, been suggested to possibly play an important role in preventing the development of neck hematomas. 8,9 However, the comparison of results of group A and group B, whereas demonstrating that the strategy of prevention based on scoring of risk significantly reduces the incidence of postoperative vomiting, on the other hand, does not confirm any correlation between the incidence of postoperative vomiting and cervical hematoma. As a matter of fact, the comparable, negligible number of episodes of cervical hematomas in both groups has no statistical relevance.…”

“…7 However, even if the patient is doing exceptionally well, bleeding can occur more than 24 hours after a thyroidectomy. 2 Postoperative vomiting has been reported as a risk factor for postoperative bleeding, 8,9 and a prophylactic antiemetic treatment is therefore advised. Prophylactic administration of ondansetron as single antiemetic drug has resulted in a reduction of the postoperative vomiting rate of about 30%.…”

To drain or not to drain after thyroid surgery: A randomized controlled trial at a tertiary Hospital in East Africa

“…The fear of an hematoma enlarging and obstructing the airway and causing difficulty in breathing, prompts many surgeons to use drains routinely after any type of thyroid surgery. The main reason is to drain off a possible postoperative haematoma, which may compress the airway and produce respiratory failure 1,4,7,8 . A prospective study conducted by Tahsin et al 1 verified that routine use of drains after thyroidectomy is not effective in decreasing the rate of postoperative complications.…”