General Surgery 21 



CONTUSION. HEMATOMA. 



A contusion is a traumatic lesion in which the subcutaneous 

 tissue elements are lacerated, but in which there is no manifest ex- 

 ternal solution of continuity. The amount of damage may be of 

 any grade from simple capillary extravasations of blood into the are- 

 olar tissue (ecchymosis) to rupture of large vessels with profuse 

 hemorrhage producing a sac of blood (hematoma), to pulpification 

 of a large mass of tissue with impairment or destruction of tissue 

 vitality. In a hematoma the blood accumulates in a distinct cavity 

 in the tissues. The blood soon coagulates excepting when it exists 

 in serous sacs. Cell proliferation takes place at the border and the 

 blood pigment is gradually absorbed until only a clear serum re- 

 mains. Suppuration may also occur. Besides the local disturb- 

 ances, it is a remarkable fact that deep-seated and grave lesions 

 often occur at remote points following violent shocks, notably dis- 

 turbances of the cerebro-spinal fluid and rupture of visceral organs. 

 Cadeac has recorded instances of death from rupture of the portal 

 vein, right auricle, anterior and posterior vena cavae, respectively, 

 and Goubaux and myself cases from rupture of the liver. 



Symptoms and Diagnosis. Contusions give rise to tenderness 

 and swelling. There may or may not be discoloration of the skin. 

 Recent hematomata fluctuate, but old-standing ones have a firm 

 circumscribed border with a soft fluctuating center, owing to fibrous 

 tissue formation. They are distinguished from abscess by a his- 

 tory of occurrence of the swelling immediately after the trauma- 

 tism and by absence of inflammatory phenomena. In the region of 

 the abdomen they must be carefully differentiated from hernia, for 

 which they are liable to be mistaken. 



Treatment. Simple contusions are best left to natural processes 

 of repair. Recent accumulations of blood should not be incised, 

 unless infection has taken place, but they should be aspirated. Ex- 

 ception to this rule must be noted in the case of hematoma of the 

 ear-flap, where experience has shown that the shortest road to repair 

 is by free incision, turning out of the fluid blood and clots, and 

 bringing the separated tissue into apposition with sutures passed 

 right through the thickness of the flap. Hematomata undergoing 

 organization are best removed by enucleation after exposure of the 

 sac by incision through the skin. In severe contusions hot antis- 



