What to do if the seam gets wet after surgery, causes and methods of treatment. Seroma after breast surgery - causes, symptoms, prevention Serous discharge after surgery

Serous fluid is not the biggest postoperative problem, but some complications can still occur that cause discomfort to the person. The accumulation of fluid occurs at the intersection of capillaries. That is, there is an accumulation of lymph within the cavity, which is located near the aponeurosis and fatty tissue under the human skin. That is why such complications most often occur in dense people with a large fat layer under the skin.

During the development of a disease associated with serous fluid, there may be straw colored discharge, which do not differ in an unpleasant odor, but a strong edema may appear, and sometimes a person even feels pain in the place where the seroma accumulates.

Most often, the accumulation of serous fluid occurs precisely after surgery. For example, plastic surgery can be distinguished, after which fluid accumulates, which leads to negative consequences. These side effects do not affect human health in any way, but nevertheless, such undesirable phenomena as sagging skin in places where fluid accumulates can appear, which by itself spoils the aesthetic appearance of a person. In addition, seroma increases the healing time of the skin, and because of this, you have to visit the doctor more often, which also causes inconvenience.

Causes of seroma

Over the entire period of operations, a variety of factors have been noted that can lead to the formation of seroma under the skin, but the main cause is lymph capillaries. In addition, another cause can be inflammatory processes that occur at the sites of injured tissues. The thing is that during the operation, doctors also touch extraneous tissues, which begin to become inflamed and lead to the accumulation of seroma.

Also one of the main reasons consider such factors, how:

• high blood pressure;
• elderly age;
• diabetes.

That is why doctors, before performing an operation, are obliged to check a person so that there are no complications in the future. If doctors learn from tests that a person may have a seroma after surgery, then they will try to change the concept of treatment in order to avoid such complications for the patient.

Patients should know before surgery whether seroma formation is possible or not. This liquid safe for humans, but still, in rare cases, its large accumulation under the skin of a person leads to dangerous diseases. For example, complications may appear in the form of necrosis of the skin flap, sepsis, or the period of wound healing after surgery can significantly increase.

Seroma formation after mastectomy and tummy tuck

As mentioned earlier, seroma can occur after plastic surgery, but mastectomy and tummy tuck are most often isolated. The formation of serous fluid occurs in almost 15% of all cases of mastectomy, and this is a fairly high chance of complications.

Naturally, breast surgery leads to the most common factor in the accumulation of serous fluid, namely the spread of lymph nodes and their number in this area of ​​the body. During breast surgery, a lot of incision of the skin, which affects not only a large number of blood vessels, but also lymph nodes. As a result, already at the stage of healing due to the occurrence of an inflammatory reaction, a serous fluid appears under the skin.

Before performing a mastectomy, doctors warn their patients about the possibility of a seroma. During abdominoplasty, the chances of fluid accumulation under the skin increase even more, because here seroma appears in almost half of the cases of plastic surgery. In fact, the reason is identical, because when the skin is cut on the abdomen, doctors touch a large number of blood vessels and lymph nodes, which, of course, lead to inflammatory processes in the future.

Treatment of accumulation of serous fluid

As a rule, serous fluid after surgery resolves on its own within 4-20 days, but still it is impossible to leave even such a frivolous complication without attention. It is important to consult a doctor who, at a critical moment, will be able to advise and carry out treatment. There are several techniques that allow, in the early stages or in case of a critical situation, to remove serous fluid.

vacuum aspiration

Vacuum aspiration is one of the most common treatments for serous fluid. Such a technique, unfortunately, can only be carried out in the early stages of the onset of complications. The purpose of vacuum aspiration is to use a special device, to which the tube is connected and descends to the lowest part, where serous fluid has formed. With the help of vacuum action, the liquid is pulled out of the wound.

When using this method of treatment, there is no opening of the old postoperative wound. In addition, pumping out serous fluid promotes the speedy healing of the skin after surgery, so many clients use vacuum aspiration only to quickly return to their normal lives.

Use of drainage for seroma

Drainage is used quite often in the case of treatment with the accumulation of serous fluid. This method can be used at any stage of seroma development, in contrast to vacuum aspiration. Wound secretions are pumped out using a special device, but it is important to consider the sterility of the device. That is why drains can only be used once, after which they are sent for recycling. Such drains are stored in special antiseptic solutions, and before starting work, all equipment treated with sodium chloride solution 0.9%.

Special devices that assist in the treatment of serous fluid may be inserted through the stitches left after the operation. In addition, the device can also be removed through a small puncture, which is made near the postoperative sutures. Fixing devices is also done with the help of seams. Doctors are required to wipe the damaged areas and the skin located nearby every day with a 1% green solution. It is also necessary to constantly change the bandage.

When using a drainage tube to drain serous fluid, you can use rubber or glass hoses for lengthening. It goes without saying that even additional materials for lengthening must be sterile, and the vessels must be filled 1/4 of any antiseptic solution. All this must be done in order to minimize the risk of infection through the stitches or wound. Therefore, in addition, daily replacement of tubes is also carried out.

The serous fluid is slightly viscous, so patients are placed on their backs on a special bed so that they can, in some cases, take care of the drainage tube themselves. In any case, doctors conduct constant monitoring of the patient.

Serous fluid can be quite viscous, but in this case, drainage with an electric pump is used.

It goes without saying that it is better not to treat gray, but to pre-carry out preventive actions that help to avoid its occurrence. Allocate several preventive measures.

Conclusion

The occurrence of postoperative seroma is not taken into account by many, but in the end this can lead not only to discomfort, but also to serious illness or simply deformities of the skin. The removal of serous fluid is quick and painless, so this should not be put off indefinitely. It is easiest to prevent the occurrence of seroma even in the early stages of formation than to carry out a second operation later.

The seroma of the postoperative suture is the accumulation of lymph in the places where scars form after mechanical dissection of the skin. Between the fat layer and the intersection of the capillaries, there is an excessive accumulation of serous fluid, which, as its volume increases, seeps through the insufficiently dense tissues of the scar. This physiological phenomenon causes significant discomfort, and the postoperative suture requires careful care and antiseptic treatment so that infectious inflammation of the wound surface does not occur. Most often, overweight people suffer from seroma, who have a large accumulation of fatty tissue in the subcutaneous layer of the abdomen.

What it is?

Serous discharge, if bacterial infection of the suture has not occurred, does not have a specific odor. Liquid discharge corresponds to the shade of lymph and has a light straw color. The presence of an abundant accumulation of fluid under the skin of a part of the body that has recently been operated on provokes swelling, and sometimes severe pain. These are the side effects of surgery. It is impossible to exclude.

In addition to discomfort and pain, seroma can provoke long-term complications that manifest themselves over subsequent years. These include extensive sagging of the skin in places where there was an excessive accumulation of lymph. In addition, the postoperative suture heals 2-3 times longer than the standard terms of tissue regeneration due to the fact that it is constantly wetted with liquid secretions. If they are found, you should immediately visit the surgeon who performed the operation.

The presence of large volumes of fluid in the subcutaneous layer requires its removal by surgical intervention.

Causes of Seroma

The accumulation of serous fluid in the area where the surgical suture is located is caused by the presence of a wide variety of factors that took place at the time of surgery. Basically, the following causes of seroma development are distinguished:

Most of these potential causes that can cause postoperative complications are identified by doctors a few days before surgery. The patient takes a blood test for sugar levels, clotting, the presence of chronic diseases of an infectious origin. A comprehensive examination of the body, all its organs and systems is also carried out. Therefore, if some pathology has been established, then the patient is prescribed a specific treatment immediately after the operation in order to prevent the development of seroma. For example, in a diabetic patient during the recovery period, insulin administration is increased to the maximum limit in order to lower the level of glucose concentration in the blood as much as possible and prevent tissue necrosis around the suture, as is often the case in patients with this endocrine disease.

Treatment of postoperative seroma

The accumulation of serous fluid under the surface of the postoperative suture in most cases disappears within 4-20 days. The timing of the natural outflow of lymph largely depends on the complexity of the operation and the extent of the surgical intervention. In the presence of seroma, the patient should be observed by the surgeon who performed the operation for the entire period of rehabilitation and receive guidelines for caring for the damaged part of the body. If the volume of lymph in the subcutaneous layer becomes critically large and there is a threat of developing inflammation or sepsis, then a specific treatment is carried out in relation to the patient, aimed at eliminating the liquid formation. Consider in more detail the methods of treatment of seroma.

Vacuum aspiration

Vacuum aspiration is one of the therapeutic methods for removing serous fluid. It is used in the early stages of the development of the disease, when there is no inflammatory process, but according to the doctor, there is a high percentage of probability that the seroma itself will not resolve. The essence of this method of treatment is that a small incision is made at the site of localization of the lymph, into which a tube of a medical vacuum apparatus is inserted. With the help of it, the mechanical removal of serous fluid beyond the subcutaneous layer is performed.

After this procedure, the healing process of the postoperative wound is several times faster and patients feel much better. The disadvantage of this method of treatment is that after the vacuum outflow of lymph, its re-accumulation is not excluded, because the device does not eliminate the very cause of the development of seroma, but only fights its consequences. Therefore, immediately after vacuum aspiration, the task of the attending physician is to search for factors that contributed to the accumulation of lymph under the surface of the postoperative suture.

Drainage treatment

The use of a drainage system is a common method of surgical treatment of congestive formations in various parts of the body. The difference between this method of treatment and vacuum aspiration is that the doctor does not use medical equipment for a one-time outflow of serous fluid. Drainage involves ensuring a constant outflow of lymph from the operated area. For this, a puncture is made in the area of ​​​​the postoperative suture. A sterile drainage system with a collection of biological material is inserted into it. After connecting it to the patient's body, a natural outflow of lymph occurs.

The drainage system ensures the removal of serous fluid from the subcutaneous layer as it enters.

Each drain is used only once, and once disconnected, it is recycled as medical waste. When performing the drainage procedure, an important aspect is to maintain maximum sterility. Before connection, the components of the drainage are soaked in an antiseptic solution of sodium chloride with a concentration of 0.9%. The drainage connection point is fixed with additional sutures, which are subject to daily treatment with brilliant green, iodocerin or hydrogen peroxide. If possible, the drainage site is covered with a sterile gauze dressing, which must be changed daily.

Prevention

Timely preventive measures are always better than a long and often painful treatment. Especially when it comes to surgical procedures. In order to prevent the development of seroma, each patient should be aware of the following preventive techniques:

1. Upon completion of the operation, a small load weighing up to 1 kg should be placed in place of the seam. Most often, bags with well-dried salt or ordinary sand are used.
2. Installation of traditional surgical drainage for the first 2-3 days after surgery.
3. Taking vitamins and minerals to increase the protective function of the immune system and speed up the process of regeneration of tissues damaged during surgery.
4. Reception of antibacterial drugs in the first 3 days after suturing. The type of antibiotics should be prescribed by the treating surgeon.

Also, you should always remember that the seam must be made with high quality without gaps. This will ensure that there are no pockets at the junctions of the cut tissues and will not allow infection to enter the wound, which often becomes one of the factors in the development of seroma.

Serous fluid after surgery is a complication that occurs due to the intersection of the lymphatic capillaries. In this case, there is an accumulation of lymph in the cavity between the aponeurosis and subcutaneous fatty tissue. This unpleasant phenomenon is especially pronounced in obese people.

With the development of this disease, a straw-colored serous fluid is discharged from the wound without any odor, which can be accompanied by severe swelling, and sometimes pain.

Very often, serous fluid appears after various, for example, after such a popular procedure as a mastectomy. Often, the seroma resolves on its own after 7-20 days. However, a very large amount of liquid stretches the skin and leads to its unpleasant sagging. All this causes great anxiety and discomfort for the patient. Seroma causes a longer recovery period and constant visits to the doctor. According to statistics, almost half of all operated patients experience this unpleasant phenomenon.

Reasons for this phenomenon

It should be noted that a huge number of factors can affect the formation of a seroma. However, the main of these factors is the violation of the lymphatic capillaries. Doctors also believe that this phenomenon appears due to severe inflammation of the secreted fluid. During surgery, nearby tissues are injured, which causes inflammation at the site of the intervention.

Overweight, high blood pressure, old age, diabetes can lead to the accumulation of serous fluid. That is why, before starting the operation, the doctor necessarily conducts a complete examination of the patient in order to determine the presence of any ailments that can cause such complications.

Patients must be aware of the possibility of seroma. Although serous fluid does not pose a great danger to humans, its large accumulation can lead to very serious consequences. Such complications include necrosis of the skin flap, sepsis, and very long wound healing. Such complications are quite rare and only if timely treatment has not been carried out.

Seroma after mastectomy and abdominoplasty

As practice shows, this unpleasant phenomenon can be observed in 15-18% of mastectomy cases.

The most significant factor that causes seroma after breast surgery is the distribution and number of lymph nodes.

During the mastectomy, there is a large dissection and tissue trauma, severe damage to the lymphatic and blood vessels, which leads to the appearance of a seroma.

Doctors warn that this unpleasant phenomenon is observed in 5-50% of cases of abdominoplasty. This complication may occur due to a large incision of the skin on the abdomen and damage to blood vessels and lymphatic channels.

vacuum aspiration

Doctors often use vacuum aspiration to remove accumulated serous fluid.

During this procedure, liquid is suctioned from body cavities and postoperative wounds using a special apparatus.

To remove a seroma, a flexible tube is attached to a vacuum aspiration machine and inserted into the lowest part of the wound or cavity.

Most often, this method of removing accumulated fluid is used in the early postoperative period.

This procedure ensures the fastest healing of postoperative wounds.

All wounds heal in a fairly short period of time, so that the patient can return to normal life as soon as possible.

Drainage for seroma

Drainage is a fairly popular therapeutic method for removing discharge from wounds. A prerequisite is that all drainages should be as sterile as possible and used only once. For storage, such drains are placed in an antiseptic solution. Before starting the procedure, they are treated with a 0.9% sodium chloride solution.

Special devices can be removed through the wound, but most often specialists remove them through special punctures located near the wounds. They are fixed with sutures. Nearby skin should be wiped every day with a 1% solution of brilliant green. You also need to constantly change gauze bandages.

The drainage tube from the patient can be lengthened with the help of rubber and glass tubes and vessels into which it falls. Such devices must be sterile and filled ¼ part with an antiseptic solution. To prevent infections from entering the wound through these tubes, they must be changed daily. This is done by the attending physician.

In order for the serous fluid to flow into the vessel as easily as possible, the patient must lie on his back, on a special bed. It is necessary to lie so that the drainage is visible, and it is convenient to take care of it.

Active drainage with an electric suction can be applied.

In this case, the medical worker necessarily monitors his work, maintaining the necessary pressure in the system and monitors the occupancy of the vessel. If the vessel is full, then it must be replaced with another one.

Removal of tubular drains is carried out only by a professional. If during the manipulations the drainage falls out of the wound, then the doctors refuse to use it further. As mentioned above, the entire procedure should be as sterile as possible.

Other treatments for seroma

Often, doctors prescribe antibiotic therapy or antimicrobial and anti-inflammatory drugs to the patient. Ketorol and nise are very popular. Also, the doctor may prescribe physiotherapy procedures (laser therapy).

At home, it is necessary to properly treat the wound and prevent various infections from entering it. You can independently apply Vishnevsky ointment or Levomekol ointment to the wound site. You can use these ointments 2-3 times a day. It is necessary to smear the wound site carefully, slightly pressing on the diseased areas of the skin.

After the operation, doctors recommend performing various thermal procedures in the area of ​​​​a large accumulation of serous fluid. To do this, you can use a cloth bag with heated salt or sand. Electric heating pads can also be used if desired. It is necessary to ensure that the heating pad is not too hot, otherwise you can burn the skin.

If these methods do not give the desired results, then the doctor will most likely perform a minor surgical intervention. The suture opens slightly and a small metal probe is used to allow the accumulated subcutaneous fluid to exit. After that, the wound is washed and rubber drainage is inserted into it for several days. After a couple of days, the wound heals.

Seroma prevention

There are a number of preventive measures that will help avoid the accumulation of serous fluid at the site of the operation:

1. Thorough closure of wounds without leaving pockets.
2. Weight or pressure bandage on the wound area for several hours. For these purposes, you can use a small bag of sand.
3. Drainage accordion.
4. Carrying out various activities that will help increase the body's resistance to infection.
5. Constant use of antiseptics or antibiotics at all stages of treatment (before surgery, immediately after it, and then as prescribed by a doctor).

If a large accumulation of serous fluid is detected after surgery, you should immediately seek medical help. Self-treatment of seroma can lead to the appearance of various complications, which will be very difficult to deal with in the future.

Drainage, or drainage in medicine - this is a special therapeutic method, the purpose of which is to remove the contents - purulent formations, exudate, various fluids from a wound or cavity. For this procedure, special tubes, rubber and gauze strips, gauze swabs are used. With their help, unhindered removal of pathological formations and fluids from the body is carried out.

Drainage, or drainage can lead to irreparable consequences and complications. For example, a very common complication after the end of drainage in the treatment of biliary tract disease is the so-called catheter withdrawal syndrome. This syndrome occurs in one fifth of patients with external drainage.

The syndrome manifests itself in the occurrence of tension in the right hypochondrium and persistent pain after removal of the catheter - a special drainage rubber tube. Such inflammatory phenomena usually disappear on their own after about four to five days from the start of conservative treatment. Moreover, there is a pattern: the earlier the catheter is removed, the greater the possibility of the occurrence and development of the syndrome of the removed catheter appears. Therefore, the most optimal timing for catheter removal is two to three weeks after drainage.

So that drainage does not end with complications and undesirable consequences, a number of requirements are put forward for it.

• The patient should not take any special position during drainage.
• During the entire period of treatment and wound healing, drainage should be unimpeded.
• The tube used during drainage should not be bent along its entire length, squeezed, put pressure on the skin - this is very important.
• Drainage systems must be installed so that they cannot compress nerves and blood vessels, otherwise it will lead to more.
• The drain tube must be well secured so that it cannot fall out. If the tube does fall out, it should be put back in immediately (moreover, only a doctor can do this).
• If the amount of discharge has increased sharply, its nature has changed, the nurse should immediately inform the doctor.
• Pumping out the contents of the cavities through the drainage is exclusively and only a medical manipulation.

When fixing the drainage system, you need to understand that there should not be much resistance from the water valve. To do this, it must be immersed in an antiseptic solution to a depth of no more than two to three centimeters. If this is not done, the contents will accumulate in the cavity instead of draining through the drain.

However, the flow of air into the drainage tube when not immersed in the valve will immediately lead to the occurrence of pneumothorax with the ensuing consequences.

Hello, 18 days ago I had an abdominal operation to remove the gallbladder with one large stone. The seam, it seems, heals well, does not hurt, but the temperature rises to 37.4 in the evening. After the operation, it did not subside at all, it was always in the range of 37.4-37.8, now it is 36.8 in the morning. But the question is not this, but the fact that two days ago I woke up in the morning all wet in the area of ​​\u200b\u200bthe seam, a small hole formed on the seam from which a yellow liquid flows out, odorless, very similar to thick yellow chicken broth, for a day this liquid stood out, where 500 gamma ran out in a day, and then it seemed that the hole began to tighten, but last night it reappeared and this liquid flowed again, at night it was all wet again, what could it be, I’ll get to the surgeon only after 2 days. What is it all about? Thanks in advance for your reply

Tatyana, Kokshetau

ANSWERED: 10/09/2016

Hello, thank you for your question and detailed description. This is a seroma after a surgical suture. It's not scary. Subcutaneous fatty tissue heals somewhat longer than the skin itself. Somewhere in the subcutaneous fat layer, the serous fluid did not accumulate and now found an outflow.

Clarifying question 11.01.2017 Natalia Nikitina, Tula

Hello. On November 22, there was an operation band. Peretonitis, the small intestine was brought out (ileustoma), then the stoma began to leave and a funnel formed and it was impossible to glue the colostomy bag, they escaped as best they could. More than a liter flowed out of the stoma in a day, everything around was burned. We went for a consultation with a doctor (as recommended) to an oncologist and I was left in the hospital. A decision was made to reconstruct the stoma. The second operation was carried out on 11 December. And now the sutures were removed and the sutures parted in two places, holes formed and a slightly viscous yellowish liquid flows, what should I do? I have diabetes.

ANSWERED: 01/12/2017

Hello, thank you for the detailed description, do nothing, you clearly described everything that has already happened, now you will definitely have an observation by the operating surgeon, it’s better than him to have a nickname about you, or rather, he doesn’t know about your stomach.

Similar questions:

Serous fluid (seroma) is a transparent moisture secreted by the serous membranes of the internal cavity of the body. Its secretion is a natural result of the functioning of the body. The appearance of serous moisture is associated with the filtration of blood vessel fluid, and therefore it contains protein, leukocytes, mesothelial cells and some other cell elements.

In case of failures in blood and lymph circulation, an excess of moisture can accumulate, sometimes accompanied by copious secretions. Most often, this condition occurs after surgery. The appearance of a seroma in a patient can be observed 2-3 days after the intervention. In the normal course of the recovery process, it disappears by the 3rd week after the operation. In case of further accumulation and release of transudate, additional treatment is required.

Signs of seroma formation in the body

An enlarged area of ​​surgical intervention is the main symptom of a developing disorder. This symptom most often occurs after liposuction and plastic surgery for implants. After removing a huge amount of fat from the internal cavity, serous moisture begins to accumulate in the resulting voids. The introduction of the implant may be accompanied by rejection, due to which a yellow liquid accumulates between the foreign element and the soft tissues.

Pathological secretions of serous fluid are determined by the swelling of the area of ​​surgical intervention. Palpation of this area can cause discomfort to the patient. Often, mild pains accompany the patient without pressure on the swelling and can be aggravated with minor physical exertion. As the seroma passes into severe stages, the colic becomes more intense.

One of the signs of seroma formation is hyperemia of the skin in the area of ​​the operation. With a moderate release of transudate, this symptom most often does not appear. It occurs when a huge amount of excess moisture accumulates in the cavity and indicates the need for its urgent removal from the body.

The discharge of serous moisture from the suture is a rare symptom indicating a severe form of the disorder. Starting the treatment process often leads to the formation of a fistulous tract, through which fluid flows out and begins to ooze out.

Reasons for the development of seroma

Most often, the accumulation of serous fluid is associated with a large wound surface, accompanied by detachment of the subcutaneous tissue. The surgical intervention should be accompanied by the most delicate treatment of the internal cavity. Rough work with fabrics, use of low-quality tools is unacceptable. The cuts are made in one motion, quickly but accurately. The use of blunt instruments, the unsteady hand of the surgeon, turns the area of ​​​​operative intervention into a "porridge" of damaged tissues that bleed and are destroyed by enzymes, which leads to the formation of a huge amount

A large wound surface is simultaneously accompanied by the destruction of the lymph nodes. Unlike blood vessels, they are not endowed with such a rapid ability to heal and heal within a day after surgery. Repeated injuries of the lymph nodes lead to increased secretion of serous transudate.

The cause of the development of seroma of the postoperative suture may be increased bleeding of internal tissues. Through small capillaries, blood enters the operated area, forming small hemorrhages. After a while, they dissolve, forming a clear liquid.

Another situation for the occurrence of seroma is the development of a postoperative hematoma in a patient. The source of filling the cavity with blood is not capillaries, but large vessels, damage to which always leads to the formation of bruises. In this case, the seroma appears only 5-7 days after the operation. Resorption of the hematoma is accompanied by the formation of fluid. It is necessary to carry out careful monitoring of the patient during the first days after the operation in order to monitor the appearance of small bruises that cannot be detected directly during the intervention.

After plastic surgery, implant rejection may occur. Some patients are highly sensitive to foreign elements. Given this factor, manufacturers strive to use the highest quality biological materials that significantly reduce the risk of rejection. But it is impossible to predict with complete certainty the reaction of the body to the implant, and therefore, due to rejection, fluid begins to accumulate in the cavity between the pectoral muscle and the implanted element.

How to treat possible complications of seroma

Neglect of seroma therapy is often complicated by suppuration in the operated cavity. Postoperative seroma is an ideal breeding ground for bacteria that enter the wound with lymph from the nasopharynx or oral cavity under the influence of chronic infectious diseases. Enriched with pathogens, the serous fluid turns into pus, which begins to poison the body.

Seroma of the postoperative scar is one of the manifestations of the inflammatory process and may be accompanied by intense formation of connective tissue. Plastic surgery for implantation, complicated by this disorder, is often accompanied by the formation of capsular contracture. Rejection of the implanted foreign body activates the secretion of serous fluid involved in the formation of a dense layer of fibrous tissue around the implant. Gradually, the capsule thickens, begins to compress the implant, which ultimately leads to breast deformity.

A long course of pathology can lead to the formation of a serous fistula in the area of ​​operation - holes in thinned tissue areas, most often along the suture line. The transudate begins to ooze through the wound on its own, thereby increasing the risk of infection and making additional surgery necessary.

The immoderate release of serous fluid prevents rapid tissue regeneration. A long course of pathology can lead to skin deformation, thinning of the subcutaneous fat layer, which reduces the aesthetic results of the intervention to nothing.

Removal of serous fluid

Therapy of seroma is carried out with the help of drug treatment and by surgical intervention. The removal of excess serous fluid from the body after surgery is facilitated by therapy with antimicrobial and anti-inflammatory drugs. The doctor prescribes to the patient the use of:

• antibiotics;
• non-steroidal anti-inflammatory drugs that help reduce the amount of transudate in the body;
• kenagol and diprospan - in some cases, the doctor prescribes the use of steroid drugs to quickly complete the inflammatory process.

At the same time, physiotherapy procedures may be prescribed. The patient must independently treat the sutures with antiseptic preparations. The use of Vishnevsky and Levomekol ointment contributes to the rapid removal of serous fluid after surgery. The preparations are applied 3 times a day by careful application to the area of ​​operation.

The insufficiency of medical treatment of seroma requires the removal of fluid surgically by performing vacuum aspiration. This manipulation is performed in most cases of excess moisture and allows you to remove seromas up to 600 ml. Vacuum aspiration consists in introducing a thin tube into the lower region of the wound, through which the device pumps out gray matter. To completely eliminate the pathology, it is necessary to carry out the procedure every 2-3 days.

To collect more serous fluid, drainage with active aspiration is used. Manipulation consists in introducing tubes through a wound or special punctures into a cavity filled with moisture. The patient should be in a supine position for some time, so that excess fluid gradually comes out. It is necessary to ensure constant monitoring of the course of drainage of the cavity, regularly carry out antiseptic treatment of the surfaces adjacent to the puncture sites.

Prevention of seroma formation

The source of secretion of serous fluid are lymphatic and venous capillaries damaged during the operation. The surgeon is required to perform the most accurate manipulations with soft tissues.

It is necessary to carefully apply electrocoagulation, trying to cauterize only damaged blood vessels. Abuse of it can lead to burns of internal tissues, followed by necrosis and inflammation. It is important to avoid pinching and excessive skin tension at the end of the operation.

Most of the measures to prevent the formation of serous fluid is the strict observance of surgical rules. Their implementation can reduce the risk of transudate up to 10%. It is necessary to carefully sew up wounds, avoiding large gaps, which can later become sources of infections that provoke the release of serous fluid into the body.

Any intervention is accompanied by damage to internal tissues and the release of products of the wound process (ichorus), which are subject to mandatory removal from the body. The success of tissue regeneration largely depends on adequate drainage of the surgical area. To avoid the negative consequences of the intervention, many surgeons recommend the use of accordion drainage. After the operation is completed, it is necessary to put a small load on the intervention area for a while.

In order to avoid complications after the operation, the patient is required to wear compression underwear. It is recommended to use high-quality knitwear that allows you to firmly compress the area of ​​​​operation. Wearing compression underwear prevents the divergence of seams, the occurrence of edema and hernia, and promotes reliable fixation of tissues. The last factor is decisive in the prevention of the occurrence of seroma.

The appearance of serous fluid in the area of ​​the postoperative suture indicates the development of a seroma. This pathology often manifests itself after mechanical damage to the skin and serous membranes. Secretion of serous fluid after surgery is normal. Its excessive secretion and accumulation under the skin is considered pathological. Seroma needs to be treated to exclude the possibility of infection of the wound surface.

Description and reasons for development

After the skin is cut during surgery, due to damage to cells and capillaries, fluid begins to accumulate between the subcutaneous fatty tissue and the dermis. In fact, it is lymph containing blood cells and protein fractions. It usually has a straw color, but sometimes becomes reddish. . This is explained by the presence in the serous discharge of a large number of leukocytes.

Seroma often provokes pain. The fluid accumulating under the skin causes swelling of the tissues adjacent to the surgical suture. They press on the wound surface, causing pain.

Discomfort is far from the biggest problem that can arise due to this pathology. It is capable of provoking complications, the consequences of which will manifest themselves for many years after surgery. For example, the patient may have sagging skin where there was a large accumulation of exudate. In addition, serous discharge from the suture after surgery increases the healing time by 3 times.

Seroma is not classified in the ICD 10 system. It does not have its own code. For this pathology, it is put down taking into account the type of surgical intervention that caused it. For example, a seroma after a caesarean section is coded O 86.0, which indicates that that the patient has suppuration of the wound and seroma of the postoperative scar.

Reasons for the development of pathology.

The main reason for the formation of exudate after surgery is the detachment of subcutaneous fatty tissue from the dermis and the formation of a large wound surface. All this is accompanied by damage to a considerable number of lymphatic vessels. The latter are closed by blood clots much more slowly than blood vessels, which provokes the release of serous fluid.

The following factors can also affect the development of seroma:

Most of the causes that can cause this pathology, doctors identify during the examination before surgery. If possible, doctors seek to eliminate negative factors before putting the patient on the operating table.

Diagnosis and treatment

Pathology is detected during a visual examination of the postoperative suture. If the doctor sees swelling around the operation area and redness of the skin, then he performs palpation. When there is a lot of fluid, then the doctor feels it flowing under the epidermis. Especially well the fluctuation is noticeable where the thickness of the skin and subcutaneous fat is small. For example, on the head.

Sometimes the doctor has doubts about the accuracy of the preliminary diagnosis. Then the patient is prescribed an ultrasound of the soft tissues. It allows you to visually see the area of ​​​​accumulation of serous fluid.

Treatment of the disease.

As a rule, after minor operations, doctors simply observe the development of the seroma. If the release of serous fluid is insignificant, then the suture is not touched, because the problem will disappear by itself. But when the surgery was severe and the accumulation of serous exudate can significantly affect the result of surgical treatment, then doctors prefer to treat this pathology.

Seroma treatment is also required in cases where fluid volumes under the skin have become critical and can provoke the development of sepsis.

There are 2 methods of treating this pathology: vacuum aspiration and drainage.

vacuum aspiration

This method is used when the disease is at an early stage, but the doctor has no doubt that in the future the pathology will not resolve itself.

The procedure is as follows:

1. The doctor makes a small incision at the site of the greatest accumulation of serous fluid.
2. Inserts into it a tube connected to a vacuum apparatus.
3. After turning on the suction, the exudate is brought out.

After vacuum aspiration, the wound heals much faster. Patients report an improvement in well-being.

This method has a serious drawback - it does not protect against relapse. The fact is that with the help of a vacuum, the consequences of the pathology are removed, but not its cause. Therefore, after the procedure, doctors have to look for factors that provoke excessive lymph secretion.

Drainage is very common in surgery. This is a simple and effective way to deal with congestion in tissues after surgery. During this procedure, the doctor makes a puncture of the skin in the area of ​​​​the surgical field and inserts a drainage system into the hole. A container for collecting liquid is attached to its outer end. Drainage provides a natural outflow of serous exudate as it forms. Drainage systems are disposable. After use, they are disposed of or recycled.

The effectiveness of this method largely depends on the observance of sterility during and after medical manipulations. Before the procedure, the components of the system are soaked in an antiseptic solution, and after it is carried out, the place where the drainage enters the skin and the seams are regularly treated with brilliant green, iodonate or hydrogen peroxide. The bandage that covers the drain should be changed every day.

To increase the effectiveness of vacuum aspiration and drainage, the patient is prescribed drug therapy. The patient receives broad-spectrum antibacterial drugs, non-steroidal and steroidal anti-inflammatory drugs. Alternative methods for the treatment of this pathology are not used.

Disease prevention

Timely preventive measures often avoid the appearance of serous exudate. . Experience shows that the following preventive measures give the best results:

Possible Complications

Neglect of the recommendations of doctors very often leads to complications of seroma. Cavities with serous contents are an ideal incubator for the development of pathogenic bacteria. Even if during and after the operation all measures were taken to protect the surgical suture from bacteria, the infection can enter the wound with lymph flow from chronic foci of inflammation in the oral cavity or nasopharynx. Having become a haven for pathogens, the exudate will quickly turn into pus and begin to have a toxic effect on the entire body.

Seroma can also cause intensive growth of connective tissue in the surgical area. If this does not create serious problems during normal operations, then with various types of implantation it can cause the formation of capsular contracture, which over time will cause deformation of the implant.

With a long course of the disease, a serous fistula may form in the subcutaneous pocket with exudate. This greatly increases the risk of secondary infection. The fistula is urgently closed surgically.

Serous fluid is not the biggest postoperative problem, but some complications can still occur that cause discomfort to the person. The accumulation of fluid occurs at the intersection of capillaries. That is, there is an accumulation of lymph within the cavity, which is located near the aponeurosis and fatty tissue under the human skin.

That is why such complications most often occur in dense people with a large fat layer under the skin. During the development of a disease associated with serous fluid, a straw-colored discharge may appear that does not have an unpleasant odor, but severe swelling may appear, and sometimes a person even feels pain in the place where the seroma accumulates.

Most often, the accumulation of serous fluid occurs precisely after surgery. For example, plastic surgery can be distinguished, after which fluid accumulates, which leads to negative consequences. These side effects do not affect human health in any way, but nevertheless, such undesirable phenomena as sagging skin in places where fluid accumulates can appear, which by itself spoils the aesthetic appearance of a person. In addition, seroma increases the healing time of the skin, and because of this, you have to visit the doctor more often, which also causes inconvenience.

At-risk groups

Theoretically, a seroma can occur after any violation of the integrity of the lymphatic vessels, which do not “know how” to quickly thrombose, as blood vessels do. While they are healing, lymph moves through them for some time, flowing from the places of ruptures into the resulting cavity. According to the ICD 10 classification system, the seroma of the postoperative suture does not have a separate code. It is put down depending on the type of operation performed and on the cause that influenced the development of this complication.

In practice, it most often happens after such cardinal surgical interventions:

• abdominal plastic;
• caesarean section (for this seroma of the postoperative suture, ICD code 10 “O 86.0”, which means suppuration of the postoperative wound and / or infiltrate in its area);
• mastectomy.

As you can see, the risk group is mainly women, and those of them who have solid subcutaneous fat deposits. Why is that? Because these deposits, when their integral structure is damaged, tend to flake off from the muscle layer. As a result, subcutaneous cavities are formed, in which fluid begins to collect from the lymphatic vessels torn during the operation.

The following patients are also at risk:

• suffering from diabetes;
• aged people (especially overweight);
• hypertension.

Causes of Seroma

The accumulation of serous fluid in the area where the surgical suture is located is caused by the presence of a wide variety of factors that took place at the time of surgery.

Basically, the following causes of seroma development are distinguished:

1. Excessive activity of lymphatic capillaries. Even an operation that does not constitute a threat to health is always a local stress for the body and skin, which was injured by a mechanical incision. Under such conditions, the lymphatic capillaries begin to actively synthesize lymph and redirect it to the site of surgical intervention. As a result of an abnormal reaction of the lymphatic system, the patient is faced with very unpleasant consequences.
2. Inflammatory process. Each body reacts differently to surgery. For some, the skin and soft tissues recover quickly and without complications, while there are patients who develop non-infectious inflammation of the wound surface with excessive accumulation of lymphatic fluid.
3. Hypertonic disease. High blood pressure can be a factor in the irrational distribution of lymph to all parts of the body.
4. Overweight. At least 75% of all patients of the surgical department who are overweight face the problem of postoperative suture healing and accumulation of serous fluid. This is facilitated by the presence of a large amount of fatty tissue. Patients who have elastic muscles in the abdomen almost never face the problem of seroma.
5. Diabetes. This is a concomitant disease, which is characterized by an increased concentration of glucose in the blood. Excess sugar does not allow the vessels and the circulatory system as a whole to function normally and restore damaged tissues.
6. old age. With aging, the intensity of metabolic processes in the body decreases. The division of cells of the epidermis, blood, soft tissues and the formation of lymph slows down. Therefore, deviations in the recovery process and the formation of serous fluid at the incision sites are possible.

Most of these potential causes that can cause postoperative complications are identified by doctors a few days before surgery. The patient takes a blood test for sugar levels, clotting, the presence of chronic diseases of an infectious origin. A comprehensive examination of the body, all its organs and systems is also carried out. Therefore, if some pathology has been established, then the patient is prescribed a specific treatment immediately after the operation in order to prevent the development of seroma. For example, in a diabetic patient during the recovery period, insulin administration is increased to the maximum limit in order to lower the level of glucose concentration in the blood as much as possible and prevent tissue necrosis around the suture, as is often the case in patients with this endocrine disease.

Seroma symptoms

A seroma may be suspected if the following symptoms are present:

• The patient has a feeling as if the lower abdomen begins to overflow with liquid.
• Sometimes there is swelling and a feeling of bulging in the lower abdomen. Patients claim that they suddenly have a sharp increase in the volume of the stomach, although this was not the case a few days ago.

If serous fluid reached large volumes then the following symptoms occur:

• Soreness or a feeling of tension in the area where the seroma has accumulated. Most often it is the lower abdomen.
• Drawing pains that begin to intensify if the patient gets to his feet.
• Redness of the skin in the place where the seroma has accumulated the most.
• General weakness, fever up to 37 degrees, fatigue.

Seroma diagnosis

Diagnosis of seroma is based on examination and instrumental research methods.

• Inspection. On examination, the surgeon will notice the presence of swelling in the lower abdomen. On palpation, there is a flow of fluid from one side to the other, a fluctuation, indicating that there is an accumulation of fluid. In addition, the presence of seroma symptoms will leave no doubt for making the correct diagnosis.
• Instrumental research methods - ultrasound of the soft tissues of the abdomen. With ultrasound, the accumulation of fluid between the muscles of the anterior abdominal wall and subcutaneous fat is very clearly visible. Given all the symptoms and the results of an ultrasound scan, it is not difficult to make a diagnosis of a seroma.

Treatment of postoperative seroma

In most postoperative cases, seroma resolves within a few days. Throughout this period, the patient is observed by the surgeon and follows his recommendations for restoring the body. If fluid does accumulate and there is a threat of infection or infection of the blood, treatment will be needed.

Seroma is treated in two ways:

1. surgical,
2. medical.

Surgical method

It is considered the easiest way to remove seroma. It is carried out with the help of a puncture. A positive result occurs in 90% of the treatment.

The surgeon pumps out liquid in a volume of up to 600 ml with a syringe. The procedure is carried out with a regularity of 3 days. Usually the course is 3-7 punctures.

Complex serous manifestations require 15 procedures. With each subsequent procedure, the liquid decreases. If the patient has thick subcutaneous fat, tissue injury is obtained in a large volume.

With such indicators, it will not be possible to solve the problem with a puncture. You will need to install a drain with active aspiration.

Drainage will allow the fluid to drain constantly until it disappears completely. To install the drainage system, it is soaked in an antiseptic.

After connection, it is fixed with additional seams, followed by regular processing. The drainage site itself is closed with a bandage with daily replacement. In this case, after a natural outflow, the cavity grows together and the seroma disappears. Drainage is carried out in conjunction with drug treatment.

Medical treatment of seroma

It consists in applying:

1. broad-spectrum antibiotics for prevention;
2. non-steroidal anti-inflammatory drugs for the treatment of aseptic inflammation;
3. anti-inflammatory steroid drugs in rare cases. These include diprospan and kenalog to block aseptic inflammation.

Folk remedies

It is important to know that regardless of the reasons for which the seroma of the postoperative suture arose, the treatment of this complication with folk remedies is not carried out. But at home, you can perform a number of actions that promote the healing of the seam and are the prevention of suppuration.

These include:

• lubrication of the seam with antiseptic agents that do not contain alcohol ("Fukortsin", "Betadine");
• application of ointments ("Levosin", "Vulnuzan", "Kontraktubeks" and others);
• inclusion in the diet of vitamins.

If suppuration has appeared in the seam area, it is necessary to treat it with antiseptic and alcohol-containing agents, for example, iodine. In addition, antibiotics and anti-inflammatory drugs are prescribed in these cases. Traditional medicine, in order to speed up the healing of the seams, recommends making compresses with an alcohol tincture of livestock. Only the roots of this herb are suitable for its preparation. They are well washed from the ground, crushed in a meat grinder, put in a jar and poured with vodka. The tincture is ready for use in 15 days. For a compress, you need to dilute it with water 1: 1 so that the skin does not burn. There are many folk remedies for healing wounds and scars after surgery. Among them are sea buckthorn oil, rosehip oil, mummy, beeswax, melted together with olive oil. These funds must be applied to gauze and applied to the scar or seam.

Seroma of the postoperative suture after caesarean section

Complications in women who delivered by caesarean section are common. One of the reasons for this phenomenon is the body of the woman in labor, weakened by pregnancy, unable to provide rapid regeneration of damaged tissues.

In addition to seroma, a ligature fistula or keloid scar may occur, and in the worst case, suppuration of the suture or sepsis. Seroma in women in labor after cesarean section is characterized by the fact that a small dense ball appears on the seam with exudate (lymph) inside. The reason for this is damaged vessels at the incision site. As a rule, it does not cause anxiety. Seroma postoperative suture after cesarean does not require treatment. The only thing a woman can do at home is to treat the scar with rosehip or sea buckthorn oil to heal it as soon as possible.

Seroma formation after mastectomy and tummy tuck

As mentioned earlier, seroma can occur after plastic surgery, but mastectomy and tummy tuck are most often isolated. The formation of serous fluid occurs in almost 15% of all cases of mastectomy, and this is a fairly high chance of complications. Naturally, breast surgery leads to the most common factor in the accumulation of serous fluid, namely the spread of lymph nodes and their number in this area of ​​the body. During the operation on the chest, a large incision of the skin occurs, which affects not only a large number of blood vessels, but also the lymph nodes.

As a result, already at the stage of healing due to the occurrence of an inflammatory reaction, a serous fluid appears under the skin. Before performing a mastectomy, doctors warn their patients about the possibility of a seroma. During abdominoplasty, the chances of fluid accumulation under the skin increase even more, because here seroma appears in almost half of the cases of plastic surgery.

In fact, the reason is identical, because when the skin is cut on the abdomen, doctors touch a large number of blood vessels and lymph nodes, which, of course, lead to inflammatory processes in the future.

After treatment

Seroma prevention

It is always better to prevent the development of complications.

To prevent the formation of subcutaneous fluid, it is enough to follow the recommendations of surgeons:

1. Immediately after the operation, a weight of up to 1 kg is placed on the suture. Salt or sand can be used as cargo.
2. In the first three days, traditional surgical drainage is installed.
3. Should be taken from day one antibacterial drugs.
4. Don't have an abdominoplasty with a thick layer of subcutaneous fat with an indicator of more than 5 cm. If more than 5 cm, then liposuction should first be performed.
5. Point impact on soft tissues. Electrocoagulation should be applied in isolation, only on bleeding vessels. You can not put pressure on soft tissues, pull them.
6. Use of high quality compression stockings. This creates good compression and fixation, which do not allow displacement of the skin-fat area.
7. Physical rest for 3 weeks.

Effects

Suppuration. In the serous fluid, bacteria multiply very quickly and the risk of suppuration is very high. Any infection - sinusitis, tonsillitis, can cause infection of the wound, as it spreads through the lymph and blood.

Mucosal formation. Appears with a long course of the disease, if the seroma after surgery does not go through treatment. It is formed both on the skin-fat flap and on the abdominal wall. If the formation of a seroma is not recognized in time, an isolated cavity with liquid will appear.

Such a prolonged state makes the skin mobile relative to the peritoneum. Such a seroma can exist for a very long time, until events occur that provoke the manifestation of this formation.

Symptoms can often be an enlarged abdomen. If you start this process, suppuration will begin. The only way to get rid of such a cavity is by surgery.

If the seroma is not diagnosed for a very long time and the seroma of the postoperative suture is not treated in a timely manner, this can lead to deformation of the skin-fat area and thinning of the fiber, which will affect the appearance of the skin.

Conclusion

The occurrence of postoperative seroma is not taken into account by many, but in the end this can lead not only to discomfort, but also to serious diseases or simply deformation of the skin. The removal of serous fluid is quick and painless, so this should not be put off indefinitely. It is easiest to prevent the occurrence of seroma even in the early stages of formation than to carry out a second operation later.