| Seroma | |
|---|---|
 | |
| A seroma on a man's right ear. | |
| Specialty | Surgery |
| Causes | Surgery (particularlybreast surgery,abdominal surgery,reconstructive surgery) |
| Diagnostic method | Physical signs,CT scan |
| Treatment | Surgical drain |
Aseroma is a pocket of clearserous fluid (filteredblood plasma). They may sometimes develop in the body aftersurgery, particularly afterbreast surgery,abdominal surgery, andreconstructive surgery. They can be diagnosed by physical signs, and with aCT scan.
Seromas can be difficult to manage. Serous fluid may leak out naturally, and a persistent leak can cause problems. Fluid can be drained, including by inserting adrain surgically. Seromas can be prevented through careful surgery, and drains can be inserted before they form. Patient posturing and position can reduce risk, as well asbreast binding after breast surgery.
Around 16th centuryCE, the word originated fromFrench:séreux, meaning "watery" later the meaning changed to "of, secreting, or containing serum". It is directly derived fromLatin:serosus, meaning "watery fluid, whey".[citation needed]
It was joined with a word-forming element fromGreek:oma, with -o-, lengthened stem vowel + -ma suffix, especially taken in medical use as "tumor" or "morbidgrowth".[citation needed]
A seroma containsserous fluid.[1] This is composed ofblood plasma that has seeped out of ruptured small blood vessels and theinflammatory fluid produced by injured and dying cells.[citation needed] Seromas are different fromhematomas, which containred blood cells, andabscesses, which containpus and result from aninfection. Serous fluid is also different fromlymph.
A seroma can usually be felt as a hard mass under the skin.[1] This may causeerythema (skin redness).[1] They can also cause significantpain.[2]
A seroma is usually caused by surgery. Seromas are particularly common afterbreast surgery[3] (e.g.,mastectomy),[4]abdominal surgery, andreconstructive surgery. It can also be seen afterneck surgery,[1]thyroid andparathyroid surgery,[5] andhernia repair.[2] The larger the surgical intervention, the more likely that seromas form. Early or improper removal of sutures can sometimes lead to formation of seroma or discharge of serous fluid from operative areas. Seromas can also sometimes be caused by injury, such as when the initial swelling from a blow or fall does not fully subside. The remainingserous fluid causes a seroma that the body usually absorbs gradually over time (often taking many days or weeks), but a knot of calcified tissue sometimes remains. Large seromas take longer to resolve than small ones, and they are more likely to undergosecondary infection. A seroma may persist for several months,[6] or even years as the surrounding tissue hardens.
Seroma is the most common surgical complication after breast surgery. It is due to the presence of rich lymphatic system in the breast, low fibrinogen levels in lymph fluid and potential space creation in the breast after surgery, which contributes to seroma formation. Seroma is more common in older and obese people.[7]
A seroma may be diagnosed based on signs on the skin.[1] OnCT scans, seromas have aradiodensity of 0–20Hounsfield units, generally in the lower part of this range, consistent with clear fluid.[8]
Gentle surgical technique with careful and meticulous control of bleeding helps avoid seromas.Liposuction contributes to seroma formation when it is done in conjunction with creating a "flap" and potential space is confluent with the treated area. Controversy exists intummy tuck surgery as to whether electrosurgical dissection either contributes to serum formation or prevents it.
Drains are traditionally used, but their use has been challenged by various authors who believe quilting sutures alone may be sufficient to reach results as good as or better than when using drains. Seromas accumulate in what is known as "dead space" where a potential place for the fluid exists. Efforts are directed at reducing or eliminating the dead space.[9] Quilting sutures reduce the risk of the skin–fat layer's separating from the deeper muscle layer, and having the separation fill up with fluid, by physically holding those layers together. Drains suck the two layers together so the body's natural "glue" (fibrin) and wound healing have a chance for a permanent bond.
Prevention of movement between the layers allows the tentative initial bond of fibrin to be reinforced by wound healing with a thin, strong, layer of scar. Avoiding certain positions for certain surgeries may have an effect. (In abdominoplasty, sitting upright with the knees bent and hips flexed will cause pressure across the lower abdomen and a tendency to seroma formation. The patient is best to stand or at least be semirecumbent). External pressure may help in immobilization, but also is thought to reduce the tendency of the fluid to leak out of vessels by increasing the backpressure on those fluid sources. Following breast augmentation or double mastectomy,binding the chest may be recommended for several weeks to minimize the risk of seromas.[citation needed]
Seromas may be difficult to manage at times. Quilting (inserting interrupted deep stitches in the wound) after mastectomy probably significantly reduces seroma formation.[10]Fine-needle aspiration is a common procedure.[1] However, it is controversial:[11] it is recommended by some for the reason that a seroma can be a culture medium for bacteria,[12] whereas others advise it only for collection of excessive amounts of fluid, because even an aspiration carried out under aseptic conditions carries a certain risk of infection.[13] Depending on its volume and duration, control of a leak may take up to a few weeks to resolve with aspiration ofserua and the application of pressure dressings.Manual lymphatic drainage conducted by a trained professional can also assist in managing and treating seromas.
If a serum or leak does not resolve (e.g., after asoft tissuebiopsy), taking the patient back to the operating room may be necessary to place some form of closed-suctiondrain into the wound.
In case oflumpectomy, the formation of a seroma at the lumpectomy site has been cited in medical literature as being beneficial, with claims that it can contribute to preserve the contour of the breast.[3][14][15]
Seromas are a treatment target in partial breast-radiation therapy.[16] In some cases, a seroma may need to be drained prior to a course of radiotherapy adjuvant to surgery.[citation needed]
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