A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are disrupted, blood plasma can seep out into the surgical area. Further, the inflammatory process can lead to additional fluid exudate. Seromas are different from hematoma (collections of blood), and from abscesses (collections of pus). 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 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 some plastic surgical procedures where large areas are undermined, leading to large raw surfaces. Seromas are usually preventable by placement of a drain at the time of surgery. However, seromas can develop after the drain is removed. Further, seromas can occur if care is not taken and a patient inadvertently pulls a drain out after surgery. Many patients find that it makes their initial recovery period more difficult, and some need repeated visits to their doctor to have the seroma fluid drained.
Pictured above is about 35 cc of seroma fluid that was drained from a patient following removal of a large lipoma. The patient accidentally pulled out her drain (that was placed during surgery), on the first post-operative night. As a result, the fluid accumulated at the surgical site and required removal with needle aspiration.
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what is the best way to care for a seroma? do u keep it cor covered with gauze?clean anddry? or let fluid be exposed to air ?
Marie,
Thank you for your questions. Seromas are fluid collections that exist within soft tissues. They are technically not open cavities, so you should not be able to cover it or expose it to the open air. Seromas need to be treated surgically, either by aspirating with a needle and syringe, or in the case of recurrent seromas, by excision of the cavity. Hope this helps.
Best,
Kevin Brenner, MD, FACS
Hi Dr. Brenner
I had a breast reduction and lift nearly a month ago. I had drains in for a week and the surgeon pulled them even though I was producing well over 20 cc per side per day. A few days later my left side dehisced and fluid came pouring out. It was horrible. I was then subjected to 2 hours of “revision” surgery with just local alone in his office freezing and wet from fluid leaking on me as I was shaking the whole time. He cut more skin off and put the drains back in. He pulled them a week later (although I strongly expressed my concern here). Then I filled right up and have been miserable. He said this has never happened to him (insinuating its something odd about me) and told me I will have to come in 2-3x per week to have fluid drained. Very condescending. My dad is a surgeon and mom is a nurse practitioner and both have expressed concerns about this being a function of technique. I dont know what to think. I now have uneven breasts (which I understand may be a function of the fluid) and horrendous looking incision areas/scars from his little “revision.” I am very worried and disgusted and dont know that I trust him. He just doesnt seem to really care much and I always feel like it is a bother to him when I go in for these aspirations. I am unclear what to expect going forward. From what I understand it seems unusual to have this problem on both sides especially after having drains in twice for a total of 2 weeks. Will this eventually resolve? Do you think this has to possibly do with surgical technique? Is it standard practice to do a large “revision” under local alone in an office? The result is worse than what I started with. Do you think another surgeon is going to be comfortable offering me a second opinion on this ongoing postop plan or would they be reluctant to jump into this mess? I really need some advice from a trustworthy source. Thank you so much for any words you can offer. By the way I am on the East Coast.
Lisa,
Thank you for your note. I sent you an email with detailed instructions.
I look forward to hearing from you.
Best,
Kevin Brenner, MD, FACS
I had a panniculectomy in Feb of 2006. My incision from that is 38″ long! It all healed great except for about a 2″ section on the right side between midline and hip. The JP drain on the left side quit draining and was pulled at approximately 2 weeks. The right drain was pulled at 8 weeks still draining 100cc every 24 hour period. I felt a large “bump” under that incision, talked to the surgeon about it and he was not concerned and said it would clear up. I forgot about it at that point. Then about three years ago I started feeling some pain and pressure in that lower right area (I am obese so there wasn’t really a visible sign). I was getting out of the shower one day and just noticed that I looked swollen in that lower right side. I went to my primary care physician and she ordered a CT Scan. It showed a large fluid-filled cyst. The Diagnostic Radiologist inserted another JP Drain. I wore it for another 8 weeks. During that time, my primary care quit seeing me. She cancelled my follow-up appointments on the drain and also my diabetes check. The Diagnostic Radiologist finally said he would do an alcohol procedure to try to irritate the lining of the cyst to hopefully seal it closed. At that time the CT sized it as 6cm x 10cm. We thought it had worked until about a year and a half ago, I started feeling the pain and pressure again. A new CT showed it was full again and now was sized at 8cm x 25cm. The local surgeon wouldn’t do surgery on me until we got my A1C under 7. It was apparent that wasn’t going to happen. So, my new primary care found a surgeon in Oklahoma City that would do the surgery since I am controlled where I am at. This surgery was June 8 of this year. After the surgery, I had a JP Drain again. The surgeon pulled that drain at 2 weeks. The original cyst laid horizontally. The incision for this surgery is vertical. A couple of weeks after the drain was pulled I noticed the area under the incision felt hard. It continued to get harder and started getting larger. The last couple of staple holes were still pussing, scabbing and draining. At 6 weeks following surgery I called the surgeons office and talked to his nurse. He was on vacation but she talked to him and he had her send me antibiotics in case it was infected and made an appointment to see him when he got back in the office the next week. At that time he aspirated it with a syringe. I know he was using a 30cc syringe and I’m sure he took at least 10 syringes out plus a smaller syringe to send for cultures. His nurse bandaged the area with several 4×4′s and lots of tape. We went to Sam’s after the Dr.’s appointment and by the time we got there (about 5 miles) the hole had continued to drain and soaked all of the 4×4′s, through the abdominal binder, my underwear and my jeans were all soaked! I went back two weeks later and it was full again. He ordered a CT to make sure we were just dealing with fluid. The following week, with confirmation that it was just fluid, I asked that it be aspirated again due to the pressure I was receiving from it and it’s location. If I pulled up to my desk, leaned on the kitchen counter to turn the faucet on, touched it in any way it was very painful. He did aspirate it and we planned a second surgery to remove it again.
The back of the original capsule is attached to the abdominal muscle wall. He took out as much of the capsule as he safely could and not compromise the strength of the muscle wall. In the second surgery, it had already started forming another capsule. I am now wearing a wound vac and have for 2 1/2 weeks. We are getting as much, if not more drainage in the wound vac as we have with the JP Drains. I guess my frustration is with the question, should the wound vac be enough negative pressure to pull the cavity closed to force it to heal closed. How long should be give it? Could the cavity close over beyond where the home health nurse can reach with her finger to keep it open? The home health nurse was trying to close the bottom of the wound and start a base of tissue to close the wound. She had it down small enough that she could just get a Q-tip through it. When my cousin and I went to my 2-week follow-up last Thursday, he goes, “no, no, no. We need that hole open to drain the fluid out of that cavity or we’ll be going right back to surgery for the same thing again.” Friday, the home health nurse stretched that opening back out with her finger (ouch) and immediately had fluid start coming up and pooling in the bottom of the wound. She carefully put a piece of sponge in the hole to hold it open and the canister on my pump has accumulated almost 200ml in it since Friday about noon.
Can you give any insights or thoughts on where the fluid may be coming from? Why there is so much fluid? Are we missing something in the treatment we are doing? Yes, I’m frustrated and need input!
I really appreciate your time and pray you can give some thoughts on why I keep forming these seromas!
Lezlie Gilbert
lg4him@yahoo.com
580.478.6159
Enid, Oklahoma
What would you call a collection of fluid that is open? I have a 1″ hole in my belly that goes down 7″ or more into a pocket of fluid. It is not pus, but the fluid is not clear either. It’s yellowish and very sticky. It formed after an infected mesh panel was removed. I have to keep it packed and it drains substantially.
It sounds to me like you have a sinus tract. This is usually something that can be repaired fairly easily. If you would like to learn more, please call my office at 310-777-5400. Thanks,
Kevin Brenner, MD, FACS
For over a year I have had a mass in my right groin. I went to the surgeon in Jan. because the pain in constant, sometimes nausiating and severe. (I have had a total hip with a rivision in 2009 and also a complete hystorectomy in Nov. 2010.) Had a CT which was not clear because of the hip followed by an ultrasound. Was told “it was very strange”. He sent me to the radiologist for a ultrasound guided needle extraction. He had seen the first ultrasound and said “you have a freaky thing there”. After three tries he only withdrew a minute amount of fluid, which was yellowish-clear, because it was like jello. He said it was a hematoma and would need surgery. Went back to the surgeon and he said wait six months and redo and ultrasound. What do you suggest?
I had a 8mm lipoma removed from my hip 8 days ago. The incision was 3.15 inches. Now it is sloshing. I went to the surgeon and he said he would not drain it as the fluid would just come back. Should I go see someone else to have it drained? Is there somehting I can do to help this go away?
Dr. Brenner,
What about seromas that form in the legs? I have a seroma on each side of my legs after all four of my muscle compartments were released. They’ve been aspirated four times. I’m on an anti-inflammatory. I wear compression stockings. I’m being told surgery is my next option. My orthopedic surgeon is telling me that he would have to scrape the tissue, put talc? powder on the tissue and then suture each layer of skin back up. Is this the normal way of handling this? I can’t find any literature on the actual removal surgery of seromas. I was hoping you could give me some insight on this.
Thank you,
Michelle