Discharge Care: Bleomycin Sclerotherapy - Right Hand Thenar Eminence / Thumb

Swelling & Expected Appearance

• Some swelling and bruising at the thenar eminence and thumb is expected and normal. Bleomycin typically causes less swelling than other sclerosants (e.g., ethanol, doxycycline), so the inflammatory response should be relatively mild.
• Swelling may peak on days 3-4 post-procedure, then gradually subside over 1-2 weeks. This delayed peak is normal.
• The area may look bruised or slightly discolored - this resolves on its own.
• Occasionally, a blood clot forms inside the treated malformation (local thrombosis), causing sudden swelling and bruising. This is uncomfortable but settles spontaneously and does not reduce treatment efficacy.

Pain Management

• Mild-to-moderate discomfort is expected for the first few days.
• Use paracetamol (acetaminophen) as first-line analgesia. Avoid NSAIDs (ibuprofen, aspirin, Motrin/Aleve) for the first 24-48 hours post-procedure as they may promote bleeding at the injection site.
• If pain is poorly controlled with simple analgesia, contact the treating team - this may warrant a short course of stronger analgesia.

Wound & Skin Care

• Keep the injection site(s) clean and dry for the first 24-48 hours.
• Do not scratch or traumatize the skin over the treated area for at least 48 hours - bleomycin can cause permanent hyperpigmentation at sites of skin trauma (so-called flagellate dermatitis pattern).
• Avoid adhesive tapes, adhesive dressings, and adhesive ECG leads applied directly over the treated skin for 7 days post-procedure - bleomycin increases the risk of hyperpigmentation under adhesive materials.
• Do not apply heat (hot water, heat packs) to the hand/thumb for the first 1-2 weeks.

Hand-Specific Precautions (Thenar / Thumb)

• Elevate the hand above heart level when resting to minimize swelling and dependent edema. This is particularly important for the first 48-72 hours.
• Avoid heavy gripping, pinching, or strenuous thumb/hand use for at least 1 week while swelling is active - the thenar eminence controls thumb opposition and grip strength; using it aggressively while inflamed may be painful and could theoretically displace the sclerosant effect zone.
• Compression dressing/bandage: If applied at discharge, keep it on as instructed (typically 24-48 hours). A soft supportive wrap helps control swelling. Ask your team whether a compression bandage or gentle splint is recommended for your specific lesion.
• Avoid submerging the hand (swimming pools, hot tubs, baths) until any injection puncture sites are fully healed (usually 5-7 days).

Bleomycin-Specific Long-Term Precautions

• Avoid smoking - bleomycin increases the risk of pulmonary toxicity, and smoking further compromises lung function.
• High-oxygen activities (scuba diving, high-altitude mountaineering) should be discussed with your treating team before undertaking, as bleomycin at higher doses sensitizes lung tissue to oxygen.
• Sun protection - avoid prolonged UV/sun exposure to the treated area for at least 7-10 days, as hyperpigmentation risk is increased.

Red Flags - Return to Hospital / ED

• Pain is severe and not controlled by prescribed analgesia
• The treated area becomes unusually hot, red, and swollen with spreading redness (signs of infection)
• Fever, chills, or general illness develops
• Rapid or unexpected increase in swelling affecting finger movement or causing numbness/tingling (possible compartment concern in the hand)
• Any difficulty breathing or chest pain (rare but bleomycin pulmonary toxicity must be excluded)

Follow-Up

• A clinical review is typically scheduled 6-8 weeks after the procedure.
• Ultrasound scan may be performed at follow-up to assess treatment response.
• If residual malformation remains or symptoms persist, a repeat session can be planned (multiple sessions are common, especially for microcystic lesions).