Seroma

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A seroma is a clear serous fluid bag that sometimes develops in the body after surgery. This fluid consists of blood plasma that has seeped out from the small blood vessels that rupture and the inflammatory fluid produced by the injured and dying cells.

Seroma differs from the hematoma, which contains red blood cells, and differs from the abscess, which contains pus and results from infection. Serous fluid is also different from the lymph.

Appointment of stitches early or inappropriately can sometimes lead to seroma formation or discharge of serous fluid from the operating area. Seromas can also sometimes be caused by injuries, such as when the initial swelling of a blow or fall does not completely subside. The remaining serous fluids cause sera which is usually absorbed by the body gradually over time (often taking several days or weeks); However, one node of calcification tissue occasionally persists.

Seroma is very common after breast surgery (eg after mastectomy), abdominal surgery, and reconstructive surgery. They are the target of treatment in partial breast radiation therapy, The greater the surgical intervention, the more likely it will appear. Larger seromas take longer to complete than small seroma, and are more likely to develop secondary infection.

Seroma can persist for several months or even years, with the tissues surrounding the seroma harder from time to time.

In CT scan, seromas have a radiation of 0-20 Hounsfield (HU) units, generally at the bottom of this range, consistent with clear liquids.

Video Seroma

Treatment

Seroma may be difficult to manage. Research shows that the quilting procedure (inserting deep sutures that are impaired in the wound) after mastectomy significantly reduces seroma formation. The removal of the seroma by fine needle aspiration is controversial: it is recommended by some people because its seroma can be a bacterial culture medium, while others suggest only to accumulate excessive amounts of fluid, because even aspirations performed under aseptic conditions carry a certain infection risk. Depending on the volume and duration of the leak, leakage control can take up to several weeks to be completed with serum aspiration and application of pressure dressings. Manual lymphatic drainage (MLD) performed by trained professionals can also assist in managing and treating sera.

If serum or leakage is not lost (eg, After soft tissue biopsy), it may be necessary to bring the patient back into the operating room to place some sort of drainage closed into the wound. This is usually unnecessary and conservative management is in effect.

In the case of lumpectomy, serum formation in the lumpectomy site has been cited in the medical literature as beneficial, with the claim that it may contribute to maintaining breast contours.

In some cases seroma may need to be dried before the adjuvant radiotherapy course for surgery.

Maps Seroma

Prevention

The main steps to prevent seroma formation are surgical and non-surgical.

1. Surgery: Sleek surgical technique with careful and meticulous bleeding control. Controversy exists in abdominoplasty surgery (abdominal tightening) as to whether the use of electrosurgical dissection either contributes to serum formation or prevents it.

Drain is traditionally used but its use has been challenged by various authors who believe that quilting sutures alone may be enough to achieve results as good or better than when using a water channel. Sera accumulates in what is known as "dead space" where the potential place for the fluid exists. Efforts are directed to reduce or eliminate dead space. The quilting suture reduces the risk of a separate skin-fat layer from the deeper muscle layers and makes the separation filled with liquid, by physically holding both layers. Drain sucks two layers together so that the body's natural glue (Fibrin) and wound healing have the opportunity for permanent bonding between the layers.

Liposuction contributes to seroma formation. When liposuction is done simultaneously by creating a "flap", and potential space united with the liposuction area, there is a greater risk of seroma. The use of effective preventive measures will minimize risks.

2. Non-surgical: Prevention of motion between layers allows Fibrin's tentative initial bond to be reinforced by wound healing with thin, strong, scarred layers. Avoiding certain positions for certain operations may have an effect. (In the abdominoplasty, sitting upright with the knees bent and the flexed hip will cause pressure in the lower abdomen and the tendency of seroma formation.The patient is better standing or at least being semi-recumbent).

 External pressure may be helpful in immobilization but is also considered to reduce the fluid tendency to exit the vessel by increasing the back pressure on the source of the fluid.

After masculinising chest reconstruction (double mastectomy) in trans men or breast augmentation, surgeons often recommend chest binding for 6 weeks to prevent seroma.