Hematomas in musculoskeletal tissue donation: do they really increase microbiological risk?

Hematoma presence in musculoskeletal tissues procured from cadaveric donors is traditionally considered a potential risk factor for microbiological contamination. This perception has led to the frequent exclusion of hematoma-bearing tissues from allograft use, despite limited scientific evidence supporting this practice. We conducted a prospective case-control study on 234 musculoskeletal tissues retrieved from 16 cadaveric donors between September 2023 and December 2024. For each tissue, data on hematoma presence and microbiological culture results were collected. Fisher's exact test was used to assess the association between hematoma presence and microbiological positivity. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. A secondary intra-donor analysis examined concordance of microbiological results in paired bilateral tissues. Hematomas were observed in 25 tissues (10.7%). Overall microbiological positivity was 5.1% (12/234), with 8.0% (2/25) in tissues with hematoma and 4.8% (10/209) in tissues without hematoma. The difference was not statistically significant (OR 1.73; 95% CI: 0.35-8.48; p = 0.62). No bilateral concordance of positivity was observed in paired tissues, and unilateral positivity was found only in tissues without hematoma. Hematoma presence in musculoskeletal tissues from cadaveric donors does not appear to significantly increase microbiological contamination risk. These findings suggest that hematoma alone should not be considered an automatic exclusion criterion. Larger studies are needed to confirm these results and guide evidence-based updates to tissue bank policies.