15 yr old female patient post op of fibroadenoma Came for suture removal but on removal black colour blood coming
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post operative fibroadenoma excision wound hematoma dark blood suture removal management
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Here is a focused clinical response for this scenario:
Post-Op Fibroadenoma Excision - Black Blood at Suture Removal
What Is Happening
Black/dark-colored blood coming from the wound at suture removal is old, deoxygenated blood - not fresh active bleeding. This is the hallmark of a wound hematoma that has been collecting in the dead space since surgery. The hemoglobin has degraded over the days post-op (methemoglobin/hemosiderin), giving it the dark/black appearance. This is a recognized post-operative complication of breast lump excision.
Why It Happens (Mechanism)
- During fibroadenoma excision, a dead space is created after the lump is removed
- If hemostasis was incomplete or a small vessel oozed after closure, blood collects in this space
- Over days, the blood degrades - oxyhemoglobin → deoxyhemoglobin → methemoglobin, turning dark/black
- The suture line acts as a barrier; on removal, the trapped collection drains out
- Seromas (clear/straw-colored fluid) can also form, but black color specifically indicates old blood = hematoma
Immediate Management Steps
1. Assessment first
- How much blood is coming out? (small ooze vs. significant collection)
- Is the wound viable - check wound edges for signs of infection (erythema, warmth, pus, odor, dehiscence)?
- Vitals - the patient is stable (this is expected to be a minor, self-limited event)
- Any fever? Tenderness beyond wound site?
2. Wound toilet
- Clean the wound with normal saline or povidone-iodine
- Gently express any remaining hematoma by mild digital pressure along the wound edges
- Allow the dead space to drain completely - do not pack tightly immediately
3. Decide on wound closure status
| Scenario | Action |
|---|---|
| Small collection, wound edges healthy, no infection signs | Leave wound open to drain, apply sterile dressing, plan secondary intention healing or delayed closure |
| Wound looks clean after drainage | Steri-strips / secondary closure possible if no infection |
| Signs of infection (pus, fever, cellulitis) | Leave open, wound swab for culture, start antibiotics (typically co-amoxiclav or cefalexin) |
| Large collection / ongoing bleeding | Refer for formal wound exploration and hematoma evacuation |
4. Dressing
- Apply moist/non-adherent dressing (e.g., Jelonet + gauze) or saline-soaked gauze
- Arrange review in 48 hours
5. Antibiotics
- Not mandatory if the wound is clean and only old hematoma is draining
- Start empirically if: wound is malodorous, there is erythema, fever, or purulent discharge alongside the blood
Follow-Up Plan
- Review wound every 2-3 days
- Educate the patient/guardian: normal for some bruising and ooze to follow; watch for increasing pain, fever, swelling, or pus
- Most small hematomas resolve completely with open drainage and dressing changes
- Ultrasound of wound site if you suspect a residual collection that is not fully draining
Key Points for a 15-Year-Old
- She is young with good healing capacity - prognosis is excellent
- Fibroadenoma excision wounds are generally small; hematomas here are usually minor
- Reassure both patient and parents - black blood at suture removal is alarming in appearance but almost always benign
- Document the finding, amount of blood, wound appearance, and your management plan in the notes
Bottom line: Dark/black blood = old hematoma draining. Perform wound toilet, allow complete drainage, assess for infection, apply dressing, and arrange close follow-up. No need for alarm unless the collection is large, ongoing, or infected.
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