Subcutaneous hematoma: treatment, symptoms, types. What is a hematoma and how to treat it

The occurrence of a hematoma occurs at the site of impact. Education is characterized by pain, the strength of which is determined by its size and the degree of tissue damage. If the muscles were injured, partial or complete limitation of their mobility is possible. Tissues in the area of the hematoma are often edematous and swollen, their temperature is elevated. Characteristic spots of bright red or dark purple color appear through the skin, remaining for quite a long time, they gradually change color to brown or greenish due to the reaction of hemoglobin breakdown, brighten to yellow and completely resolve without leaving a trace.

Do not confuse a hematoma and a bruise, focusing on the similarity of the color of the bruise. A bruise is a mild form of injury in which superficial capillaries are damaged, no serious changes occur, but a hematoma is a more complex form, often requiring urgent treatment.

The reasons

The main reason for the appearance of a hematoma is traumatic impact, as a result of which soft tissues suffer (impact, bruise, squeezing, stretching, pinching, etc.). But sometimes their occurrence provokes the use of drugs, such as acetylsalicylic acid, anticoagulants, etc. Vessel ruptures can occur not only as a result of mechanical damage, but also as a complication of certain diseases (, hemorrhagic vasculitis, Mallory-Weiss syndrome, etc.). Postoperative hematomas are also isolated.

Classification

Hematomas are classified according to many factors: according to the severity, the nature of the bleeding, according to clinical signs, according to the location, according to the state of the blood in the affected area.

Severity division:

Light form. Occurs after tissue injury during the first day. It is characterized by mild or moderate pain. Swelling and fever are not observed, motor activity is not impaired. Education, especially with timely and correctly provided first aid, is quickly regenerated and passes on its own.
Middle form. Formation occurs within 3-5 hours after injury. It is characterized by the appearance of swelling, pain, and sometimes limitation of motor activity of the affected limb. A medical examination is required to determine further treatment.
Severe form. A hematoma forms within the first two hours after injury. It is characterized by swelling of the tissue, fever, severe pain, functional impairment of limb movement. The doctor determines the type of treatment and the need for surgery.

Classification according to the nature of the hemorrhage:

Arterial. Arterial blood of a bright red color is poured into the cavity, often such hematomas occupy a fairly large surface area (spilled).
Venous. Compression or violation of the integrity of the vein leads to the release of venous blood into the cavity. Such a hematoma has a bluish-violet color, it is solid and inactive.
Mixed. The most common case is when the hematoma cavity is filled with both arterial and venous blood.

Clinical signs:

Limited on the periphery have a dense appearance, softening is felt in the middle.
Encapsulated are characterized by a large accumulation of fluid, in rare cases they can resolve on their own at small sizes, however, surgery is generally required.
Pulsating and non-pulsating hematomas. Pulsation is due to the presence of a lumen with ruptures of blood vessels and arteries, subsequently a pulsating hematoma can be transformed into an arterial aneurysm. Immediate surgical intervention is required.
Diffuse ones tend to increase rapidly, they must be opened immediately to find a vessel that is bleeding.

Location:

Subcutaneous - the most common type, formations are formed on various parts of the skin, usually after an injury, or due to various diseases.
Submucosal - hematomas of the mucous membranes.
Intramuscular accompanies serious injuries, are characterized by localization inside muscle tissues.
Subfascial - hemorrhage into the fascia, followed by compression or overlap of organs.
Subserous affect the internal organs, affecting the peritoneal cavity or being localized in the lungs;
Retrochorial are hematomas that occur during pregnancy. There is a detachment of the fetal egg from the chorion, in this place a hematoma occurs, which leads to pathologies of pregnancy, in particular, to its termination.
Hematomas in the brain area are the most dangerous formations. In turn, they are divided according to the type of lesion into: subdural hematoma, epidural, intraventricular, subarachnoid and intracerebral hemorrhage. They are distinguished from other types by the most dangerous consequences for the patient and the complexity of treatment.

The state of the blood inside the hematoma:

fresh - blood that has not yet had time to clot;
curled up;
infected - an infection has joined, the onset of the inflammatory process is fixed;
festering.

Symptoms

Symptoms of hematomas of the subcutaneous tissue and muscle depend on the size of the damage, their location and depth. Characterized by pain, swelling and swelling at the site of impact, the skin changes color to crimson red or bluish purple. Sometimes there is an increase in the temperature of the injured area, limitation of limb mobility.

Hematomas of internal organs are dangerous by squeezing, disrupting their proper operation. Hemorrhage into the peritoneum provokes with concomitant sharp pain in the abdomen, nausea, vomiting, a significant rise in body temperature. And pouring blood into the lung changes its functionality, the patient complains of shortness of breath, cough, pain.

Intracranial hematomas manifest as nausea, vomiting, dizziness, loss of consciousness after trauma, followed by a light gap with good health. Psychomotor activity is observed, sometimes turning into epileptic seizures. Symptoms may be increased blood pressure, bradycardia, visual disturbances, pyramidal symptoms.

Retrochorial hematoma occurs in the first trimester of pregnancy, it is accompanied by bloody or brownish discharge from the vagina of low intensity, especially dangerous symptoms are red discharge and pain in the lower abdomen or in the lower back, indicating an increase in hematoma. Sometimes the pathology proceeds without any symptoms, and its detection is possible only on ultrasound.

Diagnostics

Diagnosis of superficial hematomas is based on their visual examination, palpation, medical history, but for other forms, additional studies using various diagnostic equipment will be required.

Subserous hematomas of the lung are determined using radiographs. The size and localization of internal hematomas are viewed on ultrasound. To clarify the diagnosis, magnetic resonance or computed tomography is prescribed. With intracranial hematomas, MRI and CT are mandatory, in addition, they make an x-ray of the head in two projections, an encephalogram. In some cases, a lumbar puncture is performed.

Treatment

The choice of treatment depends on its type, location, size. However, the most important is to provide first aid.

After an injury, cold should be applied to the site of impact: it constricts blood vessels, preventing blood from entering the tissues, and relieves swelling. The limbs can be bandaged with a tight bandage.

Surface

Small superficial hematomas tend to self-resorption. After correctly provided primary care, you can use ointments based on heparin, bodyagi, hirudin, etc., which help the hematoma resolve as soon as possible.

Complex

Larger and more complex are treated on an outpatient basis and in hospital. One of the methods used for non-infected formations is surgical opening. Small formations are opened in outpatient clinics, patients with sufficiently large hemorrhages are hospitalized. The operation is carried out under local anesthesia, the hematoma is cut, cleaned of the contents, the cavity is washed out, sutured and drained, after which a tight bandage is applied, suture removal is indicated on the 10th day. If the hematoma is infected, a similar procedure is performed, but without suturing. After surgery to open extensive or infected hematomas, a course of antibiotics is prescribed.

intracranial

Neurosurgeons are involved in the treatment of intracranial hematomas, and in each individual case, a set of necessary procedures is prescribed individually, taking into account the characteristics of such an injury.

Small intracranial hematomas, up to 40 ml in volume, are amenable to conservative treatment, provided that there are no symptoms of brain dislocation, the patient’s depression of consciousness is insignificant, and the midbrain structures have a small displacement (up to 4 mm). All other cases require immediate surgical intervention. A trepanation of the skull is performed, such an operation is done under general anesthesia. Blood is removed from the hematoma cavity with an aspirator, after which it is washed, if bleeding continues, its source is found and manipulations are carried out to eliminate it. This is a rather difficult and complex intervention, often resuscitation is carried out simultaneously with a neurosurgical operation.

Complications

Mild forms of soft tissue hematomas pass without any consequences. However, more complex and extensive hemorrhages have a number of complications. If an autopsy of such a hematoma has not been carried out, in its place, at best, scar tissue is formed, but infection and suppuration may occur. The accumulation of blood in the joint provokes such diseases as hemarthrosis, and chronic synovitis, so articular hemorrhage must be removed.

Extensive hemorrhages in the cavity of internal organs cause irritation of nerve receptors. When the paresis resolves and the outflowing blood begins to decompose, endotoxicosis occurs caused by the breakdown products of hemoglobin.

Intracranial hematomas, even after a successful operation, do not go away without consequences. Many patients complain of increased fatigue, frequent mood changes, severe anxiety, sometimes mental abnormalities, etc.

Forecast

If we are talking about hematomas of soft tissues, with a properly performed complex of medical procedures, in general, the prognosis for recovery favorable.

Retrochorial hematomas that occur in the first trimester of pregnancy, with timely diagnosis and a properly selected treatment complex, have a favorable prognosis, natural childbirth is indicated. If the pathology occurred in the later stages, a caesarean section is performed at the 38th week of pregnancy. There are no negative consequences for the mother and child.

The most difficult to predict are cerebral hematomas, since they often have poor outcome, especially when it comes to varieties such as epidural and subdural. Mild and moderate hematomas of the brain are usually completely cured, however, treatment and the healing process can take years.

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Due to internal bleeding in the tissues of organs or muscles, in some cases, cavities filled with blood are formed. In medicine, this phenomenon is called hematomas, and it actually has little to do with ordinary superficial bruises. This fact is connected with the fact that complications arising after hematomas (depending on their location) can be very serious and quite unpredictable. Regularly occurring extensive hematomas, which are formed even as a result of minor blows and bruises, may indicate, for example, such serious diseases as vascular atherosclerosis or hemophilia. Therefore, it is extremely important not to leave constantly appearing hematomas without proper attention and to have time to seek qualified medical help in time to establish the exact cause and treatment.

Distinguishing a hematoma from an ordinary bruise is quite simple:

In the area of hematoma formation, there is a sharp pain;

Swelling at the site of injury;

Local temperature increase (skin surface is hot to the touch);

Limitation of mobility and normal functioning of muscles.

Causes of hematomas

The causes of hematomas most often include a traumatic effect on soft tissues - bruises, blows, pinching, squeezing, etc. The main mechanism for the formation of hematomas lies in the rupture of blood vessels. The size of the hematoma, the severity of its condition and the timing of treatment are directly dependent on the number of damaged vessels, their size and location.

In the same connection, experts divide hematomas into subcutaneous and formed on the internal organs. In the latter case, the degree of damage, the potential danger to the patient's condition and the appointment of competent hematoma treatment are determined exclusively in a medical hospital. The need for mandatory treatment in a medical facility is due to the fact that the accumulation of blood in the organs responsible for the functioning of the life-supporting systems of the body, for example, with a brain hematoma, can lead to complete disability of the patient or even death in a short time.

Types of hematomas

The most dangerous hematomas include their following varieties:

Hematoma during pregnancy. An increasingly common pathology during childbearing is retrochorial hematoma. A deviation that is quite dangerous for the life of the fetus and mother occurs as a result of detachment of the fetal egg from the chorion of the placenta. At the place of detachment, the nutrition of the fetal egg stops and a hematoma is formed, sometimes very extensive. The consequence of retrochorial hematoma during pregnancy can be spontaneous abortion, miscarriage, fetal hypoxia, intrauterine growth retardation and other pathologies.

Hematoma of the brain. Most often occurs as a result of a traumatic impact - a blow or a fall. The most common frontal and temporal hematomas of the brain. To confirm the diagnosis, the patient is assigned a tomographic brain examination.

epidural hematoma. This type of hematoma is a collection of blood clots in the epidural space (under the cranial surface).

- subdural hematoma. It is formed in the space between the arachnoid and hard shells of the brain. It is considered the most dangerous type of hematoma, due to the fact that it almost always leads to abnormalities in brain activity. It usually occurs in patients over the age of 60.

Clearly diagnosable symptoms characteristic of hematomas include:

soreness;

The presence of limited swelling in the area of injury;

Change in the color of the skin from red-lilac to green-yellow;

With internal hematomas, the characteristic symptoms are signs of compression of the internal organs.

Treatment of hematomas

The need and choice of tactics for the treatment of hematomas is determined by specialists and primarily depends on their variety. But if you are absolutely sure that the resulting hematoma is superficial, and you can cope with its treatment on your own, then you can recommend using the following remedies for hematomas.

With a hematoma that has arisen in the front of the head, it is necessary to apply a cold compress (preferably ice) to the area of damage as soon as possible. As a result of exposure to cold, a sharp narrowing of the blood vessels will occur, and the hematoma will stop increasing in size.

With an injury received on a limb, the best remedy for a hematoma is the imposition of a tight, pressure bandage. In this case, you need to be especially attentive to your condition, monitor body temperature and general sensations, because. there is a high probability that the process of resorption of the blood clot will not proceed actively enough, suppuration may occur in the area of \u200b\u200bthe hematoma, and then urgent medical care will be required.

At the slightest suspicion of the occurrence of a cerebral hematoma, as well as subdural, epidural or retrochorial hematomas, the possibility of self-treatment is completely excluded. The patient must be urgently hospitalized in a hospital to carry out the necessary diagnostic procedures for the presence of a brain hematoma and provide him with qualified assistance.

Folk remedies for hematomas

For traumatic injuries of small sizes, you can use the following recipes for folk remedies for hematomas:

Vodka compress (soak a gauze swab with vodka and apply to a hematoma, wrap with polyethylene, best used at night);

Salt dressings (dissolve two tablespoons of salt in 100 ml of water, soak a clean cloth made of natural fibers with the resulting solution, strengthen the saline lotion at the site of the hematoma with an elastic bandage);

A compress from a mixture of vodka and vinegar (mix 100 ml of vodka and 100 ml of diluted table vinegar with 500 ml of cold boiled water, soak a tissue bandage with the resulting solution and apply to the injury area);

A mixture of radish juice and mustard powder (mix the ingredients until a slurry is obtained, apply to the hematoma and hold for a while until a tolerable burning sensation is felt, then rinse with room temperature water, for the most effective result - this compress is recommended to be applied daily).

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Hematoma- this is the accumulation of blood in a limited cavity of the human body. The formation of hematomas is associated with rupture of blood vessels, in which blood collects at the site of injury and is surrounded by a sheath of connective tissue.

Hematomas are usually caused by open and closed injuries of organs and tissues and vascular diseases, in which their permeability increases. It is not difficult to determine the presence of a hematoma, since a blue, black or purple bruise appears at the site of injury.

Hematomas after bruises usually resolve on their own or after the use of special creams and ointments. Extensive superficial bruising and bruising of internal organs often require medical intervention.

Ointment for hematoma

Modern pharmacology offers an extensive arsenal of tools to combat hematomas. A variety of ointments and creams have anti-inflammatory and anti-edematous effects, anesthetize the site of injury, accelerate blood resorption and restore damaged capillaries.

The most popular and at the same time inexpensive means for dealing with bruises are heparin ointment and gel " Troxevasin". These drugs have long been used in medicine as a means to treat venous circulation and quickly get rid of hematomas. Troxerutin - the active component of "Troxevasin" - strengthens the walls of blood vessels, and heparin in the composition of heparin ointment dissolves clotted blood, which contributes to the rapid disappearance of bruising.

Gel "Lyoton"- an effective remedy for resolving bruises, reducing swelling and dissolving hematomas. "Lyoton" has a disinfecting effect, so it can be applied even to an open wound surface. The gel prevents the formation of scars and accelerates the restoration of normal skin, which is especially important in the treatment of hematomas on the face and open areas of the body.

It has a powerful absorbing and healing effect gel "Badyaga". It was created on the basis of the freshwater badyagi sponge - a product that contains a whole range of healing organic substances. Gel "Badyaga" perfectly helps with bruises and hematomas, if applied immediately after a bruise.

Balm "Rescuer" consists of natural ingredients: fir oil, essential oils, extracts of mountain ash and calendula. It heals wounds and bruises much faster than other drugs of the same composition.

Symptoms of a hematoma

It is not difficult to notice a superficial hematoma, because swelling and bruising form at the site of the bruise. Deep-lying tissue hematoma often occurs after surgery and is accompanied by redness and swelling.

The following symptoms are characteristic of a hematoma - a local increase in body temperature, which can be seen by placing a hand on the damaged area. When touched, a sharp pain is felt, sometimes there is a limitation of the mobility of the muscles located in this area of the body.

A serious threat to the health and even life of the patient is intracranial hematomas and hematomas of internal organs. Indirect signs of such hematomas may be a deterioration in the general condition of the patient, severe pain and a feeling of constriction. It is impossible to determine the presence of such damage during visual inspection, therefore, ultrasound and computed tomography methods are used for diagnosis.

Hematoma treatment

For superficial bruising, it is enough to apply a cold compress immediately after the injury, and then use an ointment or gel from bruises and bruises. The doctor may prescribe analgesics to reduce pain and prescribe physical therapy to speed up the process of tissue repair.

How to treat extensive intramuscular hematomas? In this case, clotted blood is removed by puncture, after which a pressure bandage is applied to the injured area. Ointment for the treatment of hematomas will significantly speed up the healing process.

Epidural and subdural hematomas, hematomas of the liver, intestines and other internal organs require emergency surgical intervention in a hospital setting.

Degrees of hematoma

Subcutaneous and intramuscular hematomas vary in severity.

Light hematomas form within a day after the injury, are accompanied by mild pain and the appearance of a small bruise. In most cases, they pass spontaneously or after the use of external agents.

Hematomas of an average degree are formed in 3–5 hours from the moment of a bruise and are characterized by moderate morbidity. With moderate hematoma, limb mobility is limited.

Severe hematoma occurs within one or two hours after injury, characterized by severe pain and immobility of the injured limb.

Moderate and severe hematomas require contacting a traumatologist for symptomatic treatment.

After the resulting bruise, a subcutaneous hematoma often forms. With such an injury, blood comes from damaged vessels and forms a cavity under the skin. Treatment of subcutaneous hematoma is usually conservative. To begin with, some urgent measures need to be taken.

Give the damaged area an elevated position. If the hematoma is on the limbs, fix it and apply a pressure bandage.
Apply cold. You can use a bag, a plastic bottle with ice cubes or cold water, or just a wet towel. Cold should be kept for about 40 minutes, then take a break for 10 minutes. The first few hours should be repeated this procedure. Thus, there will be a narrowing of the subcutaneous vessels, and the bleeding will stop.
For severe pain, drink an analgesic (analgin, pentalgin, nise). The hematoma presses on the nerve endings, so the pain can be severe.

If you perform these first aid measures, it is possible that the hematoma will be hardly noticeable and will quickly regress. If the symptoms persist the next day, therapeutic measures are taken to resolve the hematoma:

Subcutaneous hematoma is large. In such cases, a puncture is performed and blood is pumped out with a syringe, then a pressure bandage is applied. If the damaged vessel is not thrombosed, bleeding may resume. Then you have to open a hematoma, look for a bleeding vessel and bandage it.

In some cases, with a slow resorption process, the subcutaneous hematoma is complicated by infection and suppurates. If this happens, you can not continue conservative treatment, you need to urgently contact a surgeon who will open the hematoma cavity, sanitize with antiseptic solutions and install drainage. Next, you will need to do dressings and take antibiotics.

With an organized hematoma, when a capsule impregnated with calcium salts is formed, the treatment is surgical. Not only the removal of the contents of the hematoma is carried out, but also the excision of the capsule.

If a subcutaneous hematoma is localized on the head, as well as nausea or loss of consciousness, immediately consult a doctor. Perhaps you have a concussion. In this case, the treatment of hematoma fades into the background.

If, after an injury, a hematoma has formed in the chest or abdomen, and you feel severe pain, including when coughing, also do not hesitate to call a doctor. Such symptoms may indicate a broken rib or damage to internal organs. If you find a hematoma near the eye, contact an optometrist.

With uncomplicated subcutaneous hematoma, the prognosis for treatment is favorable.

Bruise is a type of hematoma accumulation of blood in the subcutaneous tissue with intact skin), which is most often the result of trauma. In fact, a bruise is not a separate disease, but a manifestation or symptom of other pathologies. This is also confirmed by the fact that in the International Classification of Diseases of the tenth revision ( ICD-10) the bruise is not singled out as a separate nosological unit ( separate independent disease).

However, bruises are very common in society, and the problem of dealing with them is very relevant. A bruise on an exposed skin surface is a cosmetic defect that is difficult to hide. From a medical point of view, bruising does not pose a serious danger to the health or life of patients. However, the frequent occurrence of this symptom may indicate the presence of certain health problems. This explains the need to consult a specialist when bruising occurs.

Interesting Facts

The vast majority of bruises that occur in medical practice are the result of injuries.
Bruising occurs more easily in women than in men.
Statistically, bruising is more common in people with red hair. In second place in terms of the prevalence of this pathology are blondes. People with dark hair are the least prone to this problem.
Blacks tend to bruise as often as people of other races, but due to the color of their skin, this symptom is very difficult to notice.
The bruises on the skin of albinos are most noticeable. In the skin of such people, the melanin pigment is almost completely absent. Because of this, blood vessels and subcutaneous accumulations of blood are clearly visible.
It is believed that bruises on the legs heal a little longer than on the hands. This is due to lower blood pressure in the vessels of the lower extremities.
Bruises can form not only where there is a large amount of soft tissue. It is not uncommon to find bruises on the forehead, on the fingertips or palms, and even under the nails.

The structure of the skin and its blood supply

The mechanism of bruising and the reasons that lead to their formation are inextricably linked with the anatomical structure of the skin. In terms of anatomy, the skin has three main layers. Each of them has its own properties and plays a role in the appearance of bruises.

The skin consists of the following anatomical layers:

epidermis;
dermis;
subcutaneous fat ( hypodermis).

Epidermis

The epidermis is the most superficial and thin layer of the skin. It consists of only a few layers of cells and contains no blood vessels. Tissue nutrition occurs due to normal diffusion from the deeper layers of the skin. When bruising occurs, the epidermis does not play such a significant role as the other two layers. During closed injuries, it remains intact and performs a protective function by preventing bacteria from entering. Due to malnutrition that can accompany injury, the epithelium may die and change as it heals.

Dermis

The dermis, or the skin proper, is made up primarily of connective tissue fibers. This layer contains a number of capillaries and nerve endings. The former play a role in the appearance of bruises, since subcutaneous hematomas form only where there are blood vessels. However, hemorrhages inside the skin practically do not occur. Connective tissue fibers are located very tightly, and even a small cavity with blood in them is rarely formed. Nerve endings in the thickness of the dermis are responsible for pain during and after injury.

Subcutaneous fat

Subcutaneous fat is the deepest layer of the skin. It has a cellular structure and is represented by areas of adipose tissue separated by connective tissue septa. Since adipose tissue is a form of accumulation of nutrients for the body, this layer contains a large number of small blood vessels. They are necessary for the rapid deposition of excess nutrients in the blood, or vice versa, for their mobilization if necessary.

It is in the subcutaneous fat that hematomas are usually formed, which are bruises. Adipose tissue is softer than connective tissue, and pathological cavities are more easily formed in it. In case of traumatic damage to the vessels, a certain amount of blood will easily accumulate in this layer of the skin.

In addition to the anatomy of the skin itself, the structure of the vessels in the thickness of the skin also plays a certain role. Basically, these are capillaries. The capillary is the smallest vessel through which metabolism is normally carried out. The walls of most capillaries consist of only one layer of cells - endotheliocytes. They fit tightly to each other, preventing the uncontrolled release of fluid into the intercellular space. In addition to endothelial cells, the capillary walls also contain a small amount of connective tissue fibers. However, due to its low content, this type of vessel is very vulnerable to mechanical injury. Under the influence of external forces when crushed or hit) the wall of the capillary breaks, and a small amount of blood enters the thickness of the surrounding tissues.

The permeability of the capillary wall can change under the influence of certain medications or other biologically active substances. In this case, the endothelial cells diverge somewhat, forming small gaps and allowing the exchange of fluids to proceed faster.

Larger vessels have a sufficiently thick and strong wall, the rupture of which is quite rare. However, with strong blows or as a result of stabbing wounds, these vessels can also be damaged. Then more blood is poured into the subcutaneous fat, and the bruise lasts longer.

The cellular composition of the blood also plays a certain role in the formation of bruises and their treatment. From an anatomical point of view, blood is also a type of tissue in the human body, consisting of a specific set of cells.

The following blood cells play the most significant role in the formation of bruises:

Erythrocytes. Erythrocytes, or red blood cells, are responsible for transporting oxygen from the lungs to tissues and performing gas exchange. For the performance of this function, in particular, the hemoglobin protein contained in erythrocytes is responsible.

Leukocytes. Leukocytes, or white blood cells, perform many functions in the body. They are able to fight infection, promote a local inflammatory process, or destroy the body's own dying cells.

platelets. Platelets are not independent cells. In fact, these are fragments of larger cells located in the bone marrow. The main function of platelets is blood clotting. With the participation of a large number of additional chemical factors, platelets migrate to the damaged area of the vessels and eliminate the damage, sticking together and forming a dense thrombus. Some diseases involving platelets and blood clotting factors can cause bruising even without prior injury.

Causes of bruising

All causes of bruising can be divided into external and internal. External causes include various types of injuries, which are the most common cause. Internal causes include various diseases and pathological conditions in which subcutaneous hematomas form independently without external influence. Usually such unexpected bruises surprise patients the most. In fact, they are a rather serious symptom, the appearance of which should lead the patient to an examination by a doctor.

Bruises most often form due to the following types of injuries:

contusion;
compression;
barotrauma;
injections;
traumatic brain injury;
frostbite.

Contusion

A contusion or bruise is a type of soft tissue injury. The main feature in this case is the diffuse ingress of blood from the vascular bed into the intercellular space. From the impact, a mechanical wave is formed, which propagates through the soft tissues. As this wave passes through the capillaries, part of the blood leaves the vascular bed. In addition, inflammatory edema is established at the site of the contusion. It is an expansion of the capillaries and their overflow with blood. In this case, part of the blood can also penetrate through the walls of the vessel. Contusion of varying severity is, of course, the most common cause of bruising in everyday life and in sports.

compression

Compression is a type of mechanical injury in which there is a prolonged compression of tissues. In this case, the force of external influence can be several times weaker than with concussion, but the duration of this force is much longer. A common example of pressure is an overly tight belt or watch band. Often, bruises form after a medical tourniquet is applied. Due to the constant uniform pressure on a certain area, the metabolism in the tissues is disturbed. Vessels expand and overflow with blood to compensate for insufficient nutrition of cells. In this case, part of the blood can leave the vascular bed and accumulate in the subcutaneous fat.

barotrauma

Barotrauma refers to soft tissue damage caused by the local action of reduced pressure. It occurs during vacuum massage or cupping treatment. With an incorrectly calculated suction force or concomitant weakness of blood vessels, bruises occur on the body. In such cases, the mechanism of their appearance is the simplest. Leather is not an air tight fabric. Therefore, if an area of low pressure acts on it from the outside, then the pressure also drops in the intercellular space. The stronger the pressure, the deeper layers of the skin may be affected. With a properly calculated force of vacuum massage, the pressure also decreases in the capillaries, which causes them to expand, fill with blood, and, as a result, improve metabolism. However, if the pressure is lowered even more, blood cells begin to exit the vascular bed into the intercellular space, leading to the formation of bruises.

injections

Almost every person is familiar with bruises after intramuscular injections. Their appearance is quite understandable, since, in fact, a penetrating stabbing wound of soft tissues occurs. On the surface of the skin, the injection site is barely visible, but the needle, passing through the layers of tissues, damages a large number of capillaries. Moreover, the introduction of the drug creates a pathological cavity in the thickness of the muscle. As the solution is injected and this cavity is formed, capillary damage also occurs.

However, under normal conditions, with the correct injection into the gluteus maximus muscle, a bruise does not form. Muscle fibers are elastic and do not allow blood to enter the subcutaneous fat layer with the formation of a bruise. Problems can occur when an incorrect injection has taken place.

The most common mistakes when performing an injection in the gluteal muscle are:

Wrong choice of injection site. An injection is made in the right upper quarter of the gluteal muscle. To do this, it is mentally divided by a cross into 4 parts. When the needle enters other parts of the muscle, the risk of bruising increases. There, the layer of muscle tissue is thinner and there are more large blood vessels. Thus, there is an increased risk that the drug will not get into the thickness of the muscle, but into another tissue that does not have such good elasticity. Then more blood will return to the subcutaneous tissue. In addition to bruising, injections into other parts of the gluteus maximus are very painful and downright dangerous. Damage to the nerves that run nearby can lead to serious complications.
Insufficient penetration depth. The gluteus maximus muscle lies deep enough under the layer of subcutaneous fat. If the injection is not given to the full length of the needle, then the drug will not get into the thickness of the muscle and bruising cannot be avoided. The cavity formed in the adipose tissue will resolve for a rather long time, therefore, the therapeutic effect of the injection itself will be much worse. For this reason, in obese people with a thick subcutaneous fat layer, bruises after injections form more often. Some doctors even recommend in such cases to immediately make intramuscular injections into the muscles of the shoulder.
Infection. Infection at the injection site is not the cause of bruising as such. In this case, there is no exit of blood from the vascular bed. However, the inflammatory process under the skin, which can be observed in this case, will also be characterized by the formation of a blue spot on the skin, resembling a bruise.
Muscle tension during injection leads to increased blood supply. As a result, more blood will enter the subcutaneous fat layer, and the likelihood of bruising will increase.

Traumatic brain injury

Severe traumatic brain injury can cause bruising under the eyes ( glasses symptom). In this case, there is not always an injury directly in the eye area. The appearance of such bruises is explained as follows. During a strong blow to the head, some vessels in the cranium ( especially at the base of the skull) may be damaged. As a result, some blood will accumulate at the base of the skull. The eye socket, on the other hand, has a number of openings for the passage of blood vessels and nerves that connect it with the cranium. Thus, the accumulated blood can enter the cavity of the orbit and accumulate around the eyeball. In this case, the skin around the eye socket will acquire a bluish tint. The difference between such a bruise and the usual bruise under the eye is that it covers the entire skin around the eyes and does not extend to the cheekbones. The symptom of glasses most often appears on both eyes in parallel, but there is also a unilateral variant.

Strictly speaking, not only trauma can be the cause of a hemorrhage in the cranium. Damage to blood vessels can also occur with severely elevated blood pressure or with some other diseases. Therefore, it is more correct to consider that the symptom of glasses is a consequence of bleeding in the middle cranial fossa ( middle part of the floor of the skull). Head injuries are simply the most common cause of such bleeding.

frostbite

With frostbite of the first degree of severity ( the easiest) as you recover, blue skin may be observed. Depending on the location of the affected surface, the spot may resemble a bruise. The reason in this case will be a strong narrowing of the capillaries under the influence of low temperature and the necrosis of surface tissues.

As you can see, all mechanical injuries leading to bruising are accompanied by an accumulation of blood in the deep layers of the skin. However, there are a number of internal factors that can contribute to bruising even with mild blows. In some cases, these factors can even cause bruising on their own. In this case, the patient will not be able to explain where the bruise came from, since there was no injury as such.

Internal factors affecting the appearance of bruises are:

blood clotting;
permeability of the walls of blood vessels;
thickness of subcutaneous fat;
age;
hormonal imbalance;
avitaminosis.

Blood clotting

The worse the blood coagulates, the easier and more often the patient will bruise. When the capillaries break, the release of blood into the subcutaneous fat begins. However, due to the small diameter of these vessels, blood accumulates rather slowly, and a bruise rarely appears. Platelets and blood coagulation factors securely clog the vessel in just a few minutes. In people with clotting disorders, bleeding lasts longer, so even a slight rupture of small capillaries can lead to the formation of a subcutaneous hematoma.

The most severe type of bleeding disorder is hemophilia. This is a hereditary disease in which the blood almost does not clot and any bleeding can last for several hours. Hemophilia is relatively rare, but such people are always covered with bruises, which form with almost every push or squeeze of the skin. In addition to hemophilia, a number of other diseases of the hematopoietic system can affect blood coagulation. They decrease the number of platelets in the blood thrombocytopenia), and the microtrauma of the vessel closes somewhat longer than usual. Another cause of reduced blood clotting is the abuse or misuse of certain medications. The most common of these are aspirin and heparin. Less often, reduced blood clotting is observed with prolonged use of corticosteroid drugs.

Permeability of vessel walls

Even if the patient is all right with blood clotting, the blood can still forcefully leave the vascular bed. This is due to the increased permeability of the capillary walls. Normally, these walls create a reliable barrier between the vessel bed and surrounding tissues. However, under the influence of certain factors, the permeability of such a barrier is greatly increased. This is observed in certain infectious diseases or when taking certain medications.

Increased vascular permeability and their fragility is also observed in some systemic diseases. In these cases, bruises may appear diffusely throughout the body, regardless of previous mechanical influences from the outside.

Diseases that can independently cause bruising are:

cirrhosis of the liver;
thrombocytopenic purpura;
von Willebrand disease.

The thickness of the subcutaneous fat

As mentioned above, the anatomical features of the structure of the skin also play a role in the formation of bruises. The thicker the layer of subcutaneous fat, the easier bruising will form. This is due to the fact that adipose tissue is well supplied with blood. In addition, a cavity with blood can easily form in it in case of damage to the vessel. In people who are more sinewy and muscular, bruising is somewhat less common.

However, it should be understood that a bruise can also appear in places where there is almost no subcutaneous tissue - for example, on the palms or on the forehead. In these places, the layer of adipose tissue is very thin, but with a strong impact from the outside, the vessel can be damaged quite seriously, and blood will still accumulate under the skin. The only difference is that for the appearance of bruises in such places, the impact of much greater force is necessary.

Age

In older people, vascular permeability usually increases, capillaries become more fragile, and the skin loses its elasticity. Together, these factors explain the easier bruising in older patients.

Hormonal imbalance

The content of certain hormones in the blood can also affect the permeability of blood vessels and blood clotting. First of all, it concerns estrogen in women. Due to the decrease in their levels, bruising may occur more often. Estrogens may decrease due to certain diseases of the reproductive system ( ovarian cyst, genital infections) or during menopause. Somewhat less often, the appearance of bruises is also affected by an imbalance of other hormones with concomitant endocrine diseases.

Avitaminosis

Inadequate intake of certain vitamins can affect the strength of the vascular wall and its permeability. First of all, we are talking about vitamins C, K, P and folic acid. These substances closely interact, increasing the digestibility of each other. Ultimately, they are responsible for the sufficient formation of connective tissue in the walls of blood vessels and its strength. These vitamins also have some effect on blood clotting.

What does a bruise look like?

The resulting bruise looks like a spot on the skin, the color of which depends on the prescription of the injury. By color, all bruises can be divided into 3 main groups. They replace one another as the bruise disappears and represent stages of a single biochemical process.

The formation and resorption of a bruise goes through the following stages:

purplish red ( fresh bruise);
blue-purple color;
yellow-green color;
yellow.

Crimson red bruises

Purple-red color is inherent in fresh bruises in the first few hours after injury. It is caused by the ingestion of erythrocytes, which contain oxyhemoglobin, into the subcutaneous tissues. This is a bright red substance, which, by the way, also stains arterial blood. Thus, in the first hours, the bruise is a fresh subcutaneous hematoma. Arterial blood accumulates in the intercellular space and shines through the skin. During this period, pain is the strongest. This is due to recent trauma and irritation of pain receptors in the tissues. In the same period, inflammatory edema is formed, which is a swelling around the area of redness. Edema appears already under the influence of leukocytes, which migrate to the lesion. They secrete specific biologically active substances that increase capillary permeability. This is necessary to improve the nutrition of damaged tissues and their speedy regeneration.

Blue-purple bruises

Already on the first day after the injury, the color of the bruise gradually changes from red to blue-violet. This is due to the fact that oxyhemoglobin is gradually oxidized in the tissues. As a result, it acquires a darker shade. At this stage, the blood still continues to be in the pathological cavity under the skin, the resorption process has not yet begun. Edema gradually begins to subside on day 3-4, but the exact timing depends on the depth of the lesion and its size. Soreness is observed mainly when touching the sore spot. At rest, the patient is not disturbed. With a more thorough probing of the soft tissues around the bruise, you can feel some compaction. It is caused by the migration of leukocytes to the pathological focus and preparation for the resorption of blood in the intercellular space.

Yellow-green bruises

The bruise acquires a yellow-green tint on the 5th - 6th day after the injury. It is explained by the fact that hemoglobin gets from the destroyed erythrocytes into tissues and begins to undergo biochemical transformations. At this stage, it turns into biliverdin - a greenish pigment. Soreness by this time usually disappears and is felt only with strong local pressure. Thickening under the skin may persist, but there is no swelling of the surrounding tissues.

Yellow bruises

Bruises acquire a rather pronounced yellow color when biliverdin in the tissues turns into bilirubin. This pigment has a yellow tint. Little by little, it disappears under the action of cellular macrophages - specific cells that absorb foreign tissues. The fact is that bilirubin is normally found in bile. In the thickness of the subcutaneous tissue, it is perceived by the body as a foreign substance. The yellow color of the bruise may last for several days. Soreness at this stage is already absent and the only reminder of the injury is a slowly disappearing yellowish spot on the skin. In the case of serious injuries with deep tissue damage, a bundle of connective tissue may form in the focus. It will be felt at the site of impact for a long time after the bruise has already disappeared completely.

These phases of bruising are mainly in the case of the release of a significant amount of blood into the soft tissues. If ice was applied immediately after the injury, the amount of blood leaving the vascular bed will be less. In this case, the third and fourth stages of hemoglobin conversion will be hardly noticeable. In addition, the process of hemoglobin biotransformation and resorption of the traumatic focus can be accelerated with the help of local application of ointments, gels, lotions and compresses. In these cases, all stages of a traumatic bruise will also not be clearly visible. In addition, during the transition from one phase to another, a two-color or even three-color bruise may be observed. Colors usually change from the periphery to the center. This symptom can be observed only with extensive damage to soft tissues, when the process of biotransformation and resorption occurs unevenly within the lesion.

What to do so that the bruise does not appear or is of a minimum size?

The appearance of a traumatic bruise in most cases can be prevented if the necessary measures are taken immediately after the injury. The correct sequence of actions will lead to the fact that the blood does not leave the vascular bed, and the bruise will not appear.

There are the following methods of early prevention of a bruise:

cold;
tight bandaging;
correct limb position.

Cold

Everyone knows that in the very first minutes after an injury, it is necessary to use cold lotions. Depending on the location of the bruise, you can simply soak a gauze bandage in cold water, wrap a piece of ice in a handkerchief or towel, or simply put the limb under a stream of cold water. Low temperature will lead to vasoconstriction. As a result, blood flow to the affected area will decrease, and less of it will accumulate in the tissues. Cold can be applied during the first hours, when a pronounced and persistent inflammatory edema has not yet developed. The sooner this method of prevention is applied, the more successful the result will be. After 4 - 6 hours after the injury, the local application of cold will no longer be able to prevent the appearance of a bruise, and all forces will have to be directed to its prompt treatment.

Tight bandaging

Tight bandaging is not as effective as applying cold, but it can also prevent bruising. The procedure is the imposition of a tight bandage bandage, which will squeeze the tissue around the lesion for some time. The logic behind this procedure is simple. Tight bandaging compresses the tissues, and the blood from the affected vessel cannot form a pathological cavity. The less blood gets into the tissues around the affected vessels, the less noticeable the bruise will be in the future. An ideal option for prevention is a bandage using an elastic bandage. It stretches and wraps around the affected limb. Each next turn of the bandage covers the previous one by one third of the width of the fabric. This bandage should be worn for 1 to 2 hours after the injury. Longer tightening of tissues can seriously disrupt blood circulation.

The disadvantage of this method is the impossibility of its application for injuries on the trunk. You can apply an effective elastic bandage only on the limbs. After 2 - 3 hours after the injury, tight bandaging is no longer worth it. The blood that has left the vascular bed will no longer return to the capillaries when the tissues are compressed, and circulatory disorders will only worsen the situation.

Correct limb position

This method is used for trauma to the limbs. It is borrowed from the practice of stopping bleeding. In fact, bruising is a form of closed bleeding, in which blood accumulates under the skin. The injured limb must be raised relative to the level of the body. At the same time, its blood supply will worsen under the influence of gravity, since it is harder for the heart to drive a large amount of blood to a greater height. This method will prevent swelling and slightly reduce the likelihood of bruising.

How to speed up the resorption of bruises?

If a bruise does appear, there are several ways to get rid of it in the shortest possible time. Most of these methods are available at home. Drugs prescribed for resolving bruises usually do not have serious side effects and are prescribed without a prescription. Particular attention should be paid only to some drugs of systemic action. If taken in excess, an overdose is possible. Drugs that affect blood clotting can greatly increase the risk of strokes, heart attacks and other serious complications. Therefore, even before treating an ordinary bruise, it will still be more reliable to visit a doctor.

All funds used for the rapid resolution of bruises can be divided into the following groups:

local preparations;
systemic drugs;
physiotherapy methods;
folk methods of treatment.

Topical preparations

Topical preparations are the most convenient and common in the treatment of bruises. Most of them have only a local effect, so they do not pose a serious threat of complications if used incorrectly. This explains why ointments and gels against bruises are mostly available without a prescription. Another advantage of local treatments is the convenience of their use. Most patients use these drugs for home treatment. The disadvantage of this group can be called the same local effect. Because of it, ointments and gels can be widely used in the treatment of traumatic bruises, but for more serious pathologies, systemic treatment will be required.

Topical preparations for the treatment of bruises

Name of the drug	Release form	Active substance	Mechanism of action	Mode of application
Voltaren Emulgel		diclofenac diethylamine	It has a pronounced analgesic, anti-inflammatory and anti-edematous effect.	Apply to damaged skin 3-4 times a day
Dexpanthenol		Dexpanthenol	Weak anti-inflammatory effect, pronounced stimulating regeneration and dermatoprotective effect.	Apply 2-4 times a day to the affected area of the skin
Lyoton	Gel for external use	Heparin sodium	Antithrombotic, antiexudative action, moderate anti-inflammatory action.	Apply 1-3 times a day to the skin in the affected area and gently rub
Finalgon	Ointment for external use	nonivamide, nicoboxyl	Improving local blood circulation, analgesic, vasodilating effect.	Apply a small amount of ointment to the affected area of the skin and cover the affected area with a woolen cloth.
Troxevasin	Gel for external use	Troxerutin	Decongestant, anticoagulant, antioxidant action. Reduces the permeability and fragility of capillaries, increases their tone. Increases the density of the vascular wall, reduces the exudation of the liquid part of the plasma and the release of blood cells from the capillary.	Apply to the affected area 2 times a day, morning and evening, gently rubbing until completely absorbed.
Indovazin	Gel for external use	Indomethacin	Anti-inflammatory, analgesic, anti-edematous action. Reduces capillary permeability and exhibits a venotonic effect.	Apply 3-4 times a day with a thin layer on the affected area of the skin with light rubbing movements.
Hepatrombin	Gel for external use	Allantoin, dexpanthenol	Combined drug with antithrombotic, anti-inflammatory and tissue regeneration-improving action.	Apply a thin layer to the skin 1-3 times a day, rubbing in with light massaging movements.

It is advisable to use these funds no earlier than 6 to 8 hours after the injury. They are mainly aimed at the speedy resorption of the bruise itself and do not help prevent its appearance immediately after the injury. Their use during this period, on the contrary, will increase swelling and provoke the formation of a more pronounced bruise.

Systemic drugs

Systemic drugs are medicines taken as tablets or injections. With bruises, such drugs are rarely used, since blood accumulation is a local problem, and ointments and compresses will relieve the bruise more effectively. However, there are a number of drugs that will be useful for people who bruise very often. As explained above, a predisposing factor to bruising is increased vascular wall permeability, capillary fragility, and reduced blood clotting. It is to combat these problems that it is useful to resort to systemic drugs.

To combat the frequent appearance of bruises, the following drugs can be prescribed:

Askorutin. Askorutin is a combined preparation containing ascorbic acid and vitamin P. The drug reduces capillary permeability and reduces their fragility. Thus, the risk of bruising after an injury is reduced. Askorutin is also prescribed as maintenance therapy for certain types of hemophilia and vascular pathologies. Take the drug 1 tablet 2 to 3 times a day, the course of treatment lasts from 3 to 5 weeks. Overdose increases the risk of vascular thrombosis.
Kapilar. Kapilar is also a combined preparation, the main components of which are medicinal plants. Its intake not only strengthens the walls of capillaries and promotes normal blood circulation, but also maintains blood pressure within normal limits. The drug is often prescribed to older people suffering from the initial form of hypertension ( increased blood pressure).
Etamzilat. The drug is mainly used to stop bleeding. It is used in cases where frequent bruising is associated with serious diseases accompanied by thrombocytopenia ( decrease in platelets). Under the action of etamsylate, platelet depots in the bone marrow are activated.
Troxevasin. Troxevasin acts on the enzyme system involved in the elimination of the lesion. Its reception accelerates reparative processes in soft tissues, reduces swelling and slightly improves blood clotting.

The appointment of systemic drugs and the selection of their dose should be carried out individually. Treatment of post-traumatic bruises at home, as a rule, does not require the use of tablets or injections at all. If we are talking about concomitant pathologies of the blood coagulation system or severe vascular diseases, then other categories of drugs are used in their treatment, which should be used only as prescribed by a doctor after a thorough examination.

Physiotherapy methods

Physiotherapy is a set of treatment methods using such physical factors as magnetic radiation, electric current, ultrasonic waves, laser radiation, ultraviolet rays. The main advantage of physiotherapy procedures is their safety for the health of the patient. This is achieved through the use of dosed, as well as pulsed exposure to physical factors, which in turn leads to an acceleration of the recovery and compensatory functions of the body. In the treatment of bruises, the activation of these mechanisms plays an important role, accelerating recovery.

For local physiotherapeutic treatment of bruises, the following physiotherapeutic methods can be used:

Medicinal electrophoresis. Electrophoresis is a method using direct electric current, which promotes the rapid penetration of the drug into the surface tissues of the body. The procedure allows you to act directly on the desired area of the body and create a drug depot there. This procedure leads to a rapid restoration of the cell walls of damaged tissues, and also has an analgesic, anti-inflammatory and calming effect. The following substances are widely used for electrophoresis in the treatment of bruises: antipyrine with a solution concentration of 1 to 10% ( has analgesic and anti-inflammatory effects), aloe extract ( increases tissue regeneration and improves its nutrition).
Magnetic therapy. This method implies a complex effect of a magnetic field and laser radiation on damaged body tissues. The method has a beneficial effect on tissue regeneration, and also has an analgesic ( anesthetic), anti-edematous and anti-inflammatory effect. The following devices have found wide application: AMLT-01 ( power 5 mW, wavelength 0.80 - 0.88 µm), "Erga" ( wavelength 0.82 µm, power up to 40 mW), ALTO-05M ( wavelength 0.82 - 0.85 µm, power up to 200 mW).
UHF therapy(ultrahigh frequency therapy). UHF is a method in which an electric field of ultra-high and ultra-high frequency acts on the human body. When using UHF therapy, the following positive effects are observed: an increase in the barrier ability of cells, an improvement in trophism and tissue regeneration, an analgesic, anti-inflammatory and anti-edematous effect. Stationary devices Screen-1, Screen-2 ( 40 - 80 W) and portable ones such as UHF-66 and UHF-30 ( 15 and 30 W).
Ultrasound therapy ( UST). Ultrasound is a physiotherapeutic method, during which mechanical vibrations of ultrahigh frequency are used. Ultrasound, acting on the damaged area, is able to improve the repair and regeneration of tissues, lead to the normalization of the rheological properties of blood. It is also used for resorption of various hemorrhages, edema and exudates that occur during the formation of bruises. Ultrasound has analgesic, antispasmodic and metabolic ( improving tissue nutrition) action. The UZT-1.01F device has proven itself well ( general therapeutic), which operates at a frequency of 880 kHz and has two modes: pulsed and continuous ( 10 and 2.4 ms).

Based on the foregoing, physiotherapeutic methods can have a beneficial effect in the treatment of subcutaneous hematomas ( bruising). Various physical factors allow you to quickly eliminate swelling, relieve pain and itching, accelerate the recovery processes in damaged tissues, and eliminate the inflammatory process. However, do not forget that even physiotherapy procedures have a number of contraindications. In each individual case, it is necessary to consult a physiotherapist.

Folk methods of treatment

As mentioned above, bruising is extremely common. As a result, previous generations have accumulated a very rich experience in dealing with this problem. There are a great many folk remedies that will help you quickly get rid of bruises. Most of these remedies can be of real help in post-traumatic superficial hematomas. In particular, they will help in the fight against local pain and in the resorption of blood accumulation.

To combat bruises, there are the following traditional medicine:

Potato juice. Raw potatoes are cut into two halves and applied to the bruise with a cut. To enhance the effect, you can apply a shallow mesh to the dissected surface with a knife. This will improve the outflow of juice.
Rue. For compresses and lotions, juice or infusion of this herb is needed. To prepare the infusion, you will need 2 tablespoons of dry grass leaves and 0.5 liters of boiling water. The mixture is placed in a dark place for 2-3 hours. After that, gauze is soaked in the infusion and applied to the bruise for 15-20 minutes.
Plantain. To combat bruises, you can use both an ordinary plantain leaf, washed in boiled water, and gruel from the leaves of this plant.
Marsh marigold. For lotions, juice from young shoots of this plant is used. Gauze soaked in juice is applied to the injury site for 10-15 minutes several times on the first day after the bruise.
Infusion of garlic. To prepare the infusion, you need 3 tablespoons of fresh garlic. The heads of garlic are finely chopped and kneaded, after which 300 ml of 6% vinegar are added. The resulting mixture is infused for a day, shaking every few hours. After that, a cotton swab is moistened in an infusion of garlic and gently rubbed at the site of injury. It is advisable to repeat the procedure several times a day for several days.
Cabbage leaves. Freshly picked cabbage leaves can also be used to combat bruises. It is only necessary to pay attention that the leaf was taken not from the surface of the head, but from 2 - 3 layers of greenery. It can be tied with a bandage to a bruise and worn throughout the day.

It is important to pay attention that all plants used for treatment are thoroughly washed with warm boiled water. The fact is that the accumulation of blood under the skin is a very favorable environment for the development of a purulent infection. Since a bruise is usually obtained during an injury, microscopic damage to the skin cannot be ruled out. When using unwashed leaves of cabbage or plantain, infection can penetrate into these lesions. Therefore, rinsing plants is not an extra precaution.

In addition, it should be understood that many medicinal plants used to treat bruises are useful primarily due to their high vitamin C content and antibacterial effect. Due to these properties, they can be successfully used against bruises of a post-traumatic nature. However, if the bruises are due to blood clotting disorders, diseases of the hematopoietic system or pathology of the vascular walls, the above folk remedies are unlikely to help. In such cases, the use of some plants will even be contraindicated. Therefore, patients who often notice the appearance of bruises on the body without visible injuries should not start self-treatment with folk remedies before visiting a specialist.