case_images: PMC11670780_01
case_images: (A) Postoperative image showing the placement of a Penrose drain in the right axilla after hematoma evacuation. The drain is used to facilitate the removal of residual blood and prevent fluid accumulation, promoting proper flap healing. (B) Image taken on the sixth postoperative day, 3 days after the removal of the Penrose drain on the third day. The dressing is clean with no signs of hematoma or active bleeding. The flap appears intact, with no visible complications at this stage. (C) Image taken 3 weeks postoperatively, showing significant necrosis of the flap.
case_images: rjae812f1.jpg
case_images: PMC11670780_01_rjae812f1.jpg
case_images: f1
case_images: To facilitate drainage of any remaining blood, a Penrose tube was placed (Fig. 1A), with plans to remove it on the third post-operative day. The dressing was clean and dry with no signs of active bleeding on the third and sixth days (Fig. 1B), and the flap appeared intact and well-healed from the third to the sixth postoperative day. The liquefied hematoma became toxic to the flap, eventually leading to necrosis (Fig. 1C).
case_images: PMC11670780_02
case_images: (A) Postoperative image of the right axilla on the third postoperative day, showing the Penrose drain in place with minimal drainage observed. The flap appears intact, with no signs of complications or hematoma. (B) Postoperative image on the sixth postoperative day, where a Penrose drain is reintroduced as a proactive measure to address concerns of delayed hematoma liquefaction. The drainage volume is carefully monitored for any indications of liquefied blood. (C) Postoperative image taken 4 weeks after surgery, showing that the flap has survived without any hematoma formation. The skin appears well-healed, with no signs of complications or necrosis.
case_images: rjae812f2.jpg
case_images: PMC11670780_02_rjae812f2.jpg
case_images: f2
case_images: During this period, minimal drainage was observed, and physical examination revealed no signs of ongoing hematoma, leading to the removal of the drain (Fig. 2A). However, unlike the first case, a decision was made to reintroduce the Penrose tube on the sixth day, based on the understanding of the potential risks of delayed hematoma liquefaction (Fig. 2B). Reintroducing the Penrose tube early ensured continuous drainage, minimizing the risk of toxic effects on the flap and resulting in better clinical outcomes (Fig. 2C).