Seroma

A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are ruptured, blood plasma can seep out; inflammation caused by dying injured cells also contributes to the fluid.

Seromas are different from hematomas, which contain red blood cells, and from abscesses, which contain pus and result from an infection. Serous fluid is also different from lymph.

Seromas can also sometimes be caused by injury, such as when the initial swelling from a blow or fall does not fully subside. The remaining serous fluid causes a seroma that the body usually gradually absorbs over time (often taking many days or weeks); however, a knot of calcified tissue sometimes remains.

Seromas are particularly common after breast surgery[1] (for example after mastectomy[2]), abdominal surgeries, and reconstructive surgery. They are a treatment target in partial-breast radiation therapy,[3] The larger the surgical intervention, the more likely it is that seromas appear. Larger seromas take longer to resolve than small seromas, and are more likely to undergo secondary infection.

Seromas may persist for several months[4] or even years, with the tissue surrounding the seroma hardening over time.

Treatment

Seromas may be difficult to manage at times. Research suggests that the procedure of quilting (inserting interupted deep stitches in the wound) after mastectomy significantly reduces seroma formation.[5] The removal of seromas by fine-needle aspiration is controversial:[6] it is recommended by some for the reason that seromas can be a culture medium for bacteria,[7] whereas others advise it only for excessive amounts of fluid collection because even an aspiration carried out under aseptic conditions carries a certain risk of infection.[8] Depending on the volume and duration of leakage, control of a leak may take up to a few weeks to resolve with aspiration of serums and the application of pressure dressings. Manual Lymphatic Drainage (MLD) conducted by a trained professional can also assist in managing and treating seromas.

If a serum or leak does not resolve, for example after a soft tissue biopsy, it may be necessary to take the patient back to the operating room in order to place some form of closed suction drain into the wound. This usually is not necessary and conservative management prevails.[9]

In case of lumpectomy, the formation of a seroma at the lumpectomy site is sometimes considered helpful, in the sense that it may contribute to preserve the contour of the breast.[1][10][11]

In some cases a seroma may need to be drained prior to a course of radiotherapy adjuvent to surgery.

Prevention

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

See also

References

  1. 1 2 Michael S. Sabel (23 April 2009). Essentials of Breast Surgery: A Volume in the Surgical Foundations Series. Elsevier Health Sciences. p. 177. ISBN 0-323-07464-2.
  2. ↑ Moshe Schein; Paul N Rogers; Ari Leppäniemi,; Danny Rosin (1 October 2013). Schein's Common Sense Prevention and Management of Surgical Complications: For surgeons, residents, lawyers, and even those who never have any complications. tfm Publishing Limited. pp. 397–. ISBN 978-1-903378-98-4.
  3. ↑ Wong, Elaine K.; Truong, Pauline T.; Kader, Hosam A.; Nichol, Alan M.; Salter, Lee; Petersen, Ross; Wai, Elaine S.; Weir, Lorna; Olivotto, Ivo A. (1 October 2006), "Consistency in seroma contouring for partial breast radiotherapy: Impact of guidelines", Int J Radiat Oncol Biol Phys, 66 (2): 372–6, doi:10.1016/j.ijrobp.2006.05.066, PMID 16965989
  4. ↑ Dick Rainsbury; Dick Rainsbury & Virginia Straker (2008). Breast Reconstruction. Class Publishing Ltd. p. 142. ISBN 978-1-85959-197-0.
  5. ↑ Mannu G S, Qurihi K, Carey F, Ahmad M A, Hussien M. Quilting after mastectomy significantly reduces seroma formation. S. Afr. j. surg. [Internet]. 2015 July [cited 2016 Sep 29] ; 53( 2 ): 50-54. Available from: http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612015000200007&lng=en. http://dx.doi.org/10.7196/SAJSNEW.7864.
  6. ↑ Michael Depalma; Michael J Depalma, MD MD (2011). Ispine: Evidence-Based Interventional Spine Care. Demos Medical Publishing. p. 245. ISBN 978-1-935281-93-1.
  7. ↑ Department of Pathology University of Massachusetts Medical School (Emeritus) Guido Majno Professor; Department of Pathology University of Massachusetts Medical School (Emerita) Isabelle Joris Associate Professor (12 August 2004). Cells, Tissues, and Disease : Principles of General Pathology: Principles of General Pathology. Oxford University Press. p. 435. ISBN 978-0-19-974892-1.
  8. ↑ P. Prithvi Raj; Serdar Erdine (31 May 2012). Pain-Relieving Procedures: The Illustrated Guide. John Wiley & Sons. p. 397. ISBN 978-1-118-30045-9.
  9. ↑ Schwartz's principles of surgery: self assessment and board review, 8th edition, chapter 11, patient safety, errors, and complications in surgery
  10. ↑ A. Thomas Stavros (2004). Breast Ultrasound. Lippincott Williams & Wilkins. p. 393. ISBN 978-0-397-51624-7.
  11. ↑ M. A. Hayat (5 November 2008). Methods of Cancer Diagnosis, Therapy and Prognosis: Breast Carcinoma. Springer Science & Business Media. p. 562. ISBN 978-1-4020-8369-3.
This article is issued from Wikipedia - version of the 11/8/2016. The text is available under the Creative Commons Attribution/Share Alike but additional terms may apply for the media files.