Seroma

• Seroma is a localized collection of clear, yellowish fluid that can develop after surgery, particularly in areas where tissue has been removed or disrupted.
• They often arise from lymphatic and blood vessel leakage into dead space created by surgery, with symptoms including swelling, tenderness, and sometimes a palpable mass.
• Treatment typically involves aspiration (draining the fluid) or, less commonly, surgical removal, depending on size and symptoms.
• Preventive measures include surgical drains, compression garments, and meticulous surgical technique to minimize dead space.
• Early recognition and appropriate management are key to preventing complications like infection or delayed wound healing.

What is a Seroma?

A Seroma is a localized collection of serous fluid that accumulates in a surgical site or dead space within the body. This fluid, typically clear or yellowish, consists of blood plasma that has seeped from damaged small blood vessels and lymphatic vessels. Seromas are a common postoperative complication, particularly after procedures involving extensive tissue dissection, such as mastectomy, abdominoplasty, or hernia repair. They can range in size from small, unnoticed collections to large, noticeable swellings causing discomfort and delaying wound healing. The formation of a seroma is part of the body’s natural response to trauma and tissue disruption, as it attempts to fill the void created by surgery.

Seroma formation is a frequent complication, with incidence rates reported up to 30% after mastectomy and axillary dissection, and up to 50% in some abdominoplasty procedures. (Source: General surgical literature, e.g., studies published in journals like Plastic and Reconstructive Surgery). While often benign, large or persistent seromas can lead to complications such as infection, skin necrosis, or delayed wound healing, necessitating intervention.

Causes and Symptoms of Seroma

The primary seroma causes and symptoms arise from the body’s reaction to surgical trauma. When tissue is removed or separated, a potential space (dead space) is created. Damaged blood and lymphatic vessels in the surgical area can leak serous fluid into this space, further exacerbated by the body’s inflammatory response. Factors increasing seroma risk include:

• Extensive tissue dissection
• Lymphatic disruption
• High body mass index (BMI)
• Movement at the surgical site
• Minor bleeding

Symptoms typically manifest as a soft, often movable swelling or lump near the surgical incision. This swelling may cause a feeling of fullness, pressure, or discomfort, though it might not always be painful. Other common symptoms include:

• Visible swelling under the skin
• Tenderness or mild pain upon touch or movement
• A “sloshing” sensation upon palpation
• Skin discoloration over the seroma
• Delayed wound healing
• Fluid leakage from the incision

It is crucial to distinguish a seroma from hematomas (blood collections) or abscesses (pus collections), although a seroma can become infected and develop into an abscess.

Seroma Treatment and Prevention Strategies

Effective seroma treatment options depend on the seroma’s size, location, and symptoms. Small, asymptomatic seromas may resolve spontaneously. However, larger or symptomatic seromas often require intervention. Common treatment approaches include:

• Aspiration: The most common treatment, involving needle and syringe drainage, often repeated until fluid accumulation ceases.
• Compression: Applying a compression garment or bandage helps reduce fluid and promotes tissue adhesion post-aspiration.
• Surgical drainage: For large, persistent, or recurrent seromas, a surgical drain may be inserted for continuous fluid removal.
• Sclerotherapy: Injections of a sclerosing agent after aspiration can encourage cavity walls to adhere, preventing further fluid buildup.
• Surgical excision: Rarely, if other methods fail, the seroma capsule may be surgically removed.

To address how to prevent seroma after surgery, several strategies are employed:

• Surgical Drains: Temporary drains at the operative site remove fluid, reducing dead space and promoting tissue adherence.
• Compression Garments: Postoperative compression applies continuous pressure, minimizing fluid and supporting healing.
• Suture Techniques: Meticulous surgical closure of dead space with sutures reduces potential fluid collection.
• Minimizing Movement: Limiting activity in the surgical area during recovery prevents disruption of healing tissues.

While these strategies significantly reduce seroma incidence, complete prevention is not always possible. Patients should always follow their surgeon’s post-operative instructions carefully to minimize risks.