FIND OUT WHY
Post-op bleeding question: Sorry for the length on this one: This case is a 6 year old boxer that presented for COHAT, canine extraction, and gingivectomy in several locations. The procedures went well. I extracted 104 and 105. There was minimal hemorrhage during the procedure. I did tear the gingiva over the canine and ended up trimming some away but with releasing did get a good tension free closure. Again, minimal bleeding noted on the procedure. The sutures were close together as I usually do, and I always put a little pressure on the extraction area to see if I’ll get any leakage which I didn’t. However, approximately 2 hours after the patient was recovered I checked her and there was a considerable amount of blood on her e-collar and there was active bleeding coming through the suture line and dripping. None of the gingivectomy sites were bleeding. We watched her for a few minutes and blood continued to come out of the suture line. I put her back under anesthesia, opened the rostral aspect, and examined for bleeding. There was a clot in the extraction site and slight ooze from the bone where I’d smoothed it with the football bur. I was honestly hoping to find a vein or artery to ligate but did not find anything. In fact, there was very little bleeding. I placed vetspon in site in case once she woke up some change in hemodynamics or position would result in something bleeding again and then closed the site again. The only thing I did differently was after I’d placed all my interrupted sutures of 4-0 Monocryl I went over it with a continueous line with bites between the interrupteds. When I placed my bites the gingiva did bleed some but not excessively. After closing again I left her under for a few minutes to observe for bleeding and, when none was observed, recovered her. She did not bleed at all overnight per client and is eating and doing well today BUT her lip and right side of her muzzle are swollen today. I didn’t send NSAIDs on the outside chance I had a clotting issue.
I have done a fair number of extractions over the last 8-9 years and have had cases with post-op swelling for 24-48 hours so I’m not as surprised on that but I’ve never had post-op bleeding like this. I still don’t know if I cut a bleeder in the palate, up in the buccinator or what happened. I instructed to return for a recheck if the swelling doesn’t start to subside. I’d appreciate any input or experience in this area or possible area that I could have missed. Preop labs were good but we don’t do clotting times routinely. Platelets were fine.