Surgical Therapy Hematoma Major hematomas are a true emergency. Immediate surgical drainage is necessary to avoid flap necrosis. Often no discrete bleeding vessel is identified during surgical exploration. Direct evacuation of minor hematomas is preferred if the hematoma is detected early and is reachable easily through an existing incision. Otherwise, minor hematomas may be treated with serial needle aspirations and pressure dressing.
Antibiotic prophylaxis is suggested.
If a motor nerve is transected knowingly, immediate microscopic neurorrhaphy is indicated. If nerve injury is noted postoperatively, institute expectant management. Eliminate anesthetic effect. Transient paralysis is more likely than permanent paralysis. Infection Major infections requiring intravenous antibiotics are rare.