Management of Subgaleal Hematoma in Adults
Most cases of subgaleal hematoma in adults can be managed conservatively without surgical intervention, as they typically resolve spontaneously within 7-10 days with appropriate supportive care. 1
Initial Assessment and Stabilization
- Evaluate hemodynamic stability and assess for signs of significant blood loss, as subgaleal hematomas can cause substantial hemorrhage requiring fluid resuscitation 2
- Perform neurological examination to rule out associated intracranial injuries 1
- Obtain imaging (CT scan) to confirm diagnosis, rule out skull fractures, and assess hematoma size and extension 1
- Monitor hemoglobin/hematocrit levels, especially in patients on anticoagulants, as significant drops may indicate ongoing bleeding 1
Conservative Management (First-Line)
- Apply cold compresses to the affected area during the first 24-48 hours to reduce swelling and limit hematoma expansion 3
- Provide appropriate analgesia for pain control 4
- Apply non-elastic bandage compression to provide direct pressure over the hematoma when appropriate 5
- Monitor for hematoma expansion and signs of complications 4
- Discontinue or reverse anticoagulation if the patient is on anticoagulant therapy, after weighing risks and benefits 3, 1
Indications for Surgical Intervention
Surgical drainage should be considered in cases with:
- Massive hematomas causing significant pain or discomfort 4
- Evidence of infection or abscess formation 4, 6
- Orbital compartment syndrome or risk of airway compression 4
- Failure of conservative management with persistent or expanding hematoma 5
- Significant anemia requiring blood transfusion 4, 6
Surgical Approaches (When Indicated)
- Needle aspiration may be attempted for smaller, liquefied hematomas, though this approach often has limited success 6
- Incision and drainage is the preferred surgical approach for large hematomas requiring evacuation 4
- In complex cases, consider endoscopic-assisted evacuation to ensure complete removal while minimizing tissue trauma 2
Post-Treatment Monitoring and Follow-up
- Monitor for reaccumulation of the hematoma for at least 24-48 hours 1
- Assess for signs of infection including fever, increasing pain, or purulent drainage 6
- Schedule follow-up evaluation within 7-10 days to ensure appropriate resolution 1
Special Considerations
- Anticoagulated patients require more careful monitoring as they are at higher risk for hematoma expansion and delayed resolution 1
- Recurrent hematomas may indicate an underlying coagulation disorder requiring further investigation 3
- Traumatic cases should be evaluated for associated injuries including skull fractures 1
Complications to Watch For
- Infection and abscess formation 4
- Anemia requiring blood transfusion 6
- Orbital compartment syndrome in cases with periorbital extension 4
- Rarely, airway compromise in massive hematomas extending to the neck 4