A seroma is a collection of fluid composed of fat, serum, and lymph. Seromas commonly develop following surgery as the body tries to fill in the dead space created during surgery.
Etiology & Pathophysiology
- Accumulation of serous fluid in dead space → often occurs after hernia and breast surgery, but can occur after any surgery
- Thought to arise due to lymphatic and vascular drainage disruption through soft tissue dissection that occurs during surgery
Prevention
- Proposed techniques to reduce seroma formation (results are INCONSISTENT)
- Minimize dead space
- Excise excess skin
- Use fibrin sealant
- Quilting sutures
- Medical talc
- Drain dead space
Presentation
- Pressure-like sensation at seroma
- Palpable subcutaneous fluid collection
- Swelling, pain, and erythema may be present if the seroma is infected
Imaging
- Ultrasound: anechoic fluid collection
- CT
Treatment
- Asymptomatic seroma → often resolve spontaneously
- Symptomatic seroma (often when seroma is >100 cc) → sterile aspiration, pressure dressing
- Refractory seroma → drain placement, heal by secondary intention
- Infected seroma
- Surgical drainage and antibiotics
- Explant exposed prosthetic implants when infection is severe