Seroma is a condition in which fluid seeping out from the damaged blood vessels accumulates in tissue spaces created by a surgical procedure or else following trauma to a susceptible area. The condition is the commonest post operative complication following mastectomy procedures and it can manifest in other surgical procedures such as abdominoplasty, lymph node removal and lumpectomy as well. Although the condition is not as serious as the development of a hematoma, which is the accumulation of blood, it can become a nuisance for the patient as well as for the clinicians as repeated fluid aspirates and evacuates may be needed before a seroma disappears once and for all.
What Are Causes
A seroma is a sterile accumulation of blood serum in an area left empty by the removal of tissue inside the body. The most common location of a seroma is in the breasts of females following a lumpectomy or mastectomy. It is also frequently seen during cosmetic surgery involving liposuction. What occurs is the body recognizes that damage has been done to the area and increases capillary permeability in order to dilute the location. The fluid fills the area that was formerly occupied by body tissue. Drainage through the lymphatic system occurs much more slowly than the accumulation from the arteries so the fluid gradually builds up and forms a palpable sac.
What leads to the formation of a seroma?
As mentioned earlier, the seroma refers to the accumulated serous fluid and its origin would most likely to be the tiny blood vessels which becomes damaged due to surgery or trauma. Although the serous fluid can leak into the tissue planes, the blood cells cannot creep through and therefore the outcome would be a seroma rather than a hematoma.
It should be remembered that, the underlying problem in places such as the breast, abdomen and at sites of lymph nodes would be the dead space and at times the heavy vascularity. Because of the time it takes for these damaged blood vessels to repair themselves and the less likelihood for the surgeon to be able to tie these tiny blood vessels would make these sites considerably vulnerable to the formation of a seroma.
What are Treatment Options
A seroma is different from an abscess because an abscess forms to fight an infection. For that reason, and abscess will contain white blood cells, bacteria, and byproducts of the body´s immune response. An abscess is an infection that has been properly isolated from the rest of the body. A seroma is a sterile environment without the presence of bacteria or of byproducts of an immune response. Instead, it is the product of inflammation caused by the injury of the surrounding tissue.
The most appropriate treatment is time. As the empty space is filled with fluid, the permeability of the surrounding capillaries will be decreased. As this occurs, the lymphatic system which is responsible for the drainage of extracellular fluids will finally be able to catch up and the seroma should begin to shrink. This takes time as the lymphatic system is not equipped to handle large quantities of fluids like which are found in a seroma. A seroma that is formed from a mastectomy may take a few weeks to drain on it´s own. This natural drainage is the best solution as long as it is not causing complications.
To speed things along, heat can be applied to the area. A heat pad or hot compress should be applied for about fifteen minutes every few hours. This will increase the rate at which the fluid drains and also has the benefit of providing comfort to the area of incision. The amount of heat should not be too high, or applied to long as this will also increase capillary permeability and cause more fluid to possibly build up in the seroma. Depending on the location of the seroma, it may also be possible to temporarily elevate in order to increase drainage.
The final option is physical drainage with a syringe. This is usually avoided in all cases except where the seroma is causing health complication. Remember, a seroma is a sterile environment, free of bacteria and infection. As soon as the needle penetrates the skin and enters the fluid, bacteria have no been introduced. The real problem with this is that the sterile environment is the perfect breeding ground for bacteria. So while the senoma may be temporarily drained, more than likely an immune response battleground is going to take its place shortly.
How can a seroma be prevented from taking place?
When a surgeon performs surgeries which are prone to give rise to seromas, they will take every measure in the book to prevent it from happening although it is rather difficult to prevent this complication. Among the techniques used, insertion of a drain should be considered the main strategy which is effective in many instances. Apart from this, newer techniques in reducing the dead space created such as tucking-in a muscle flap during radical mastectomy could also be highlighted.
Following surgery, a tight bandage will be applied to the surgical site and it is expected to be in place for several days before it is removed. At the same time, resting the surgical site to prevent the wound from becoming stretched can also help reduce the fluid collection and therefore the formation of a seroma.
When a mastectomy or lumpectomy is performed, the patients are advised to wear a tight bra to exert pressure over the surgical site to make the tissue oppose and therefore leave less likelihood of fluid leak and to increase wound healing.
Preventing a possible infection at the site of the surgery is another method to avoid formation of a seroma and feeling for warmth, redness, and excessive tenderness after few days from the surgery could indicate a possible infection at the site. Furthermore, the wound should be kept clean as introducing infective agents may be detrimental to the health of the wound.
Lastly, it should be remembered that, mild buildup of fluid at the surgical site may be allowed in modern day surgery and in most instances, these will settle itself and would not lead to the development of a seroma.