An Institutional Experience of Hematoma Management after Head-and-neck Oncosurgeries

Abstract

Introduction: Management of patients with head and neck squamous cell carcinoma mainly consists of controlling the primary tumour and regional cervical nodal metastases if any. Surgical complications lead to increased hospital stay, further surgical interventions and sometimes a fatal outcome. Postoperative neck hematoma is one such potential and dreaded complication of head and neck surgeries leading to infection, airway obstruction, compression of the surrounding structures causing free flap failure or sometimes may even lead to death. Haematoma might arise from any of the unaddressed neck vessels or some major vessels in the primary site which were inadvertently injured. Aims and Objectives: Development of a checklist to minimise the incidence of haematoma. Results: Between August 2017 to March 2019 out of 548 patients operated and reconstructed with free flap, 24 patients (4.38%) had developed a post-operative haematoma. However, after following our protocol, the incidence of haematoma drastically decreased and out of 1234 patients operated between April 2019 to December 2022 only 14 patients (1.13%) developed haematoma of the neck. Conclusion: Though ours is a pilot study, we feel that our protocol is easy to follow, and we have applied it successfully in surgical practice and decreased the incidence of post-operative hematoma. We believe if the same protocol is followed and applied in surgical practice it will be of great help to all head-and-neck surgeons.

Keywords

• airway compromise
• checklist
• free flap
• hematoma
• head and neck
• neck dissection
• oncology
• reexploration