What are the management steps for postoperative bleeding through dressings after bunion surgery?

Management of Postoperative Bleeding Through Dressings After Bunion Surgery

Apply direct manual pressure to the bleeding site immediately and continuously for 5-10 minutes without interruption to achieve hemostasis. 1

Initial Hemorrhage Control

• Direct manual pressure is the first-line intervention for any external bleeding, including postoperative bleeding through surgical dressings 1
• Apply firm, continuous pressure directly over the bleeding site without lifting to check if bleeding has stopped during the initial 5-10 minute period 1
• If bleeding persists after direct pressure alone, consider applying a hemostatic dressing as adjunctive therapy while maintaining direct pressure 1
  • Hemostatic dressings achieve hemostasis in approximately 90.8% of cases and can stop bleeding in under 3 minutes in 73% of patients 1
  • These dressings are particularly useful when standard direct pressure cannot control bleeding 1

Dressing Management After Bleeding Control

• Once hemostasis is achieved, apply a pressure dressing to maintain bleeding cessation 1
• The original surgical dressing should have remained undisturbed for a minimum of 48 hours unless leakage occurred 1
• After bleeding is controlled and a new dressing applied, avoid disturbing it unnecessarily 1

Critical Assessment Points

Evaluate whether this represents:

• Simple oozing through the dressing (managed with pressure as above)
• Active arterial bleeding requiring immediate surgical consultation
• Hematoma formation requiring drainage consideration

Warning Signs Requiring Immediate Surgical Consultation:

• Pulsatile bleeding that does not respond to 10 minutes of direct pressure 1
• Rapidly expanding hematoma
• Signs of compartment syndrome (severe pain, numbness, pallor)
• Hemodynamic instability

Post-Control Monitoring

• Inspect the wound daily for signs of infection: increasing erythema, purulent drainage, warmth, tenderness, or fever 2
• Change dressings using aseptic technique to minimize infection risk 2
• If a hematoma develops, it may require drainage, but this should be performed by the surgeon 2

Common Pitfalls to Avoid

• Do not repeatedly lift the dressing to check if bleeding has stopped during the initial pressure application period—this disrupts clot formation 1
• Do not use narrow tourniquets if considering tourniquet application for life-threatening extremity bleeding, as they cause more pain and tissue damage 1
• Avoid aspirating fluid collections with needle and syringe, as this introduces skin flora and increases infection risk 2
• Do not assume advanced dressings are superior to standard dressings for routine postoperative wound care—evidence shows no significant difference in infection rates 1

When Direct Pressure Fails

If bleeding cannot be controlled with direct pressure and hemostatic dressings:

• Contact the operating surgeon immediately for evaluation
• Consider whether the patient has an underlying coagulopathy that needs correction 3
• The surgeon may need to place additional sutures for mechanical hemostasis 2