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They help to reduce graft sheer and haematoma formation. However, haematomas may still occur, especially in patients on anticoagulant therapy. The conventional method of evacuating a haematoma involves removing a few marginal stitches or staples. The sponge is then lifted minimally, and the haematoma is evacuated. The procedure can, however, be painful, time consuming and result in peripheral graft failure.
This problem can be solved by using a simple modification. The sponge dressing is incised through its full thickness, across its diameter, with a pair of dressing scissors or a no 10 blade. The incision should stop just before the margin of the dressing (Fig. 1) . The paraffin gauze can then be seen and is incised. The foam can be retracted with ease, and the haematoma is easily seen and evacuated. The incision in the sponge tie-over can then be closed with staples or tape or be overdressed. This is a rapid and relatively painless way of dealing with sub-sponge haematomas. It avoids graft shear and involves minimal disruption of the dressing.
Figure 1The sponge split to gain access to a haematoma. The sponge edges can be easily retracted to evacuate the haematoma.
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