Discharge of serous fluid from under the postoperative suture. Seroma of postoperative suture in the abdominal cavity Seroma postoperative treatment

Any surgical intervention is a big test for the patient's body. This is due to the fact that all his organs and systems experience increased stress, no matter whether the operation is small or large. It especially affects the skin, blood vessels, and, if the operation is performed under anesthesia, the heart. Sometimes, after everything seems to be over, a person is diagnosed with “seroma of the postoperative suture.” Most patients do not know what it is, so many are frightened by unfamiliar terms. In fact, seroma is not as dangerous as, for example, sepsis, although it also does not bring anything good with it. Let's look at how it happens, why it is dangerous and how it should be treated.

What is it - postoperative suture seroma?

We all know that many surgeons perform “miracles” in the operating room, literally bringing a person back from the other world. But, unfortunately, not all doctors conscientiously perform their actions during the operation. There are cases when they forget cotton swabs in the patient’s body and do not fully ensure sterility. As a result, in the operated person, the suture becomes inflamed, begins to fester or separate.

However, there are situations where problems with a stitch have nothing to do with medical negligence. That is, even if 100% sterility is observed during the operation, the patient suddenly accumulates liquid in the incision area that looks like ichor, or pus of a not very thick consistency. In such cases, they speak of seroma of the postoperative suture. What it is, in a nutshell, can be said this way: it is the formation of a cavity in the subcutaneous tissue in which serous effusion accumulates. Its consistency can vary from liquid to viscous, the color is usually straw-yellow, sometimes supplemented with blood streaks.

At-risk groups

Theoretically, seroma can occur after any violation of the integrity of lymph vessels, which do not “know how” to thrombose quickly, as blood vessels do. While they are healing, lymph continues to move through them for some time, flowing from the rupture sites into the resulting cavity. According to the ICD 10 classification system, seroma of the postoperative suture does not have a separate code. It is assigned depending on the type of operation performed and the reason that influenced the development of this complication. In practice, it most often occurs after such cardinal surgical interventions:

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

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

The following patients are also at risk:

those suffering from diabetes;
elderly people (especially overweight);
hypertensive patients.

Causes

To better understand what it is - postoperative suture seroma, you need to know why it forms. The main causes do not depend on the competence of the surgeon, but are a consequence of the body’s reaction to surgical intervention. These reasons are:

Fat deposits. This has already been mentioned, but we will add that in overly obese people whose body fat is 50 mm or more, seroma appears in almost 100% of cases. Therefore, doctors, if the patient has time, recommend liposuction before the main operation.
Large wound surface area. In such cases, too many lymph vessels are damaged, which, accordingly, release a lot of fluid and take longer to heal.

Increased tissue trauma

It was mentioned above that seroma of the postoperative suture depends little on the conscientiousness of the surgeon. But this complication directly depends on the skills of the surgeon and on the quality of his surgical instruments. The reason why seroma can occur is very simple: the work with the tissues was carried out too traumatically.

What does it mean? An experienced surgeon, when performing an operation, works with damaged tissues delicately, does not squeeze them unnecessarily with tweezers or clamps, does not grab them, does not twist them, and performs the incision quickly, in one precise movement. Of course, such jewelry work largely depends on the quality of the instrument. An inexperienced surgeon can create a so-called vinaigrette effect on the wound surface, which unnecessarily injures the tissue. In such cases, the ICD 10 code for seroma of the postoperative suture can be assigned as follows: “T 80”. This means “a complication of surgery not noted elsewhere in the classification system.”

Excessive electrocoagulation

This is another reason that causes suture gray after surgery and to some extent depends on the competence of the doctor. What is coagulation in medical practice? This is a surgical procedure performed not with a classic scalpel, but with a special coagulator that produces a high-frequency electric current. In essence, this is a targeted cauterization of blood vessels and/or cells by current. Coagulation is most often used in cosmetology. She has also proven herself excellent in surgery. But if it is performed by a physician without experience, he may incorrectly calculate the required amount of current or burn excess tissue. In this case, they undergo necrosis, and neighboring tissues become inflamed with the formation of exudate. In these cases, seroma of the postoperative suture is also assigned the code “T 80” in ICD 10, but in practice such complications are recorded very rarely.

Clinical manifestations of seroma of small sutures

If the surgical intervention was on a small area of skin, and the suture turned out to be small (accordingly, the doctor’s traumatic manipulations affected a small volume of tissue), the seroma, as a rule, does not manifest itself in any way. In medical practice, there are cases where patients did not even suspect it, but such a formation was discovered during instrumental studies. Only in isolated cases does a small seroma cause minor pain.

How to treat it and is it necessary to do it? The decision is made by the attending physician. If he deems it necessary, he may prescribe anti-inflammatory and painkillers. Also, for faster recovery, the doctor may prescribe a number of physiotherapeutic procedures.

Clinical manifestations of seroma of large sutures

If the surgical intervention affected a large volume of the patient’s tissue or the suture was too large (the wound surface is extensive), the occurrence of seroma in patients is accompanied by a number of unpleasant sensations:

redness of the skin in the suture area;
nagging pain that gets worse when standing;
during operations in the abdominal region, pain in the lower abdomen;
swelling, bulging of part of the abdomen;
temperature increase.

In addition, suppuration of both large and small seromas of the postoperative suture may occur. Treatment in such cases is very serious, including surgical intervention.

Diagnostics

We have already discussed why seroma of a postoperative suture can occur and what it is. Treatment methods for seroma, which we will consider below, largely depend on the stage of its development. In order not to start the process, this complication must be detected in time, which is especially important if it does not announce itself in any way. Diagnostics is carried out using the following methods:

Examination by the attending physician. After surgery, the doctor is required to examine his patient's wound daily. If undesirable skin reactions are detected (redness, swelling, suppuration of the suture), palpation is performed. If there is a seroma, the doctor should feel fluctuation (flow of liquid substrate) under the fingers.

Ultrasound. This analysis perfectly shows whether or not there is accumulation of liquid in the seam area.

In rare cases, a puncture is taken from the seroma to clarify the qualitative composition of the exudate and decide on further actions.

Conservative treatment

This type of therapy is most often practiced. In this case, patients are prescribed:

antibiotics (to prevent possible further suppuration);
anti-inflammatory medications (they relieve inflammation of the skin around the suture and reduce the amount of fluid released into the resulting subcutaneous cavity).

Nonsteroidal drugs such as Naproxen, Ketoprofen, and Meloxicam are more often prescribed.

In some cases, the doctor may prescribe steroidal anti-inflammatory drugs, such as Kenalog, Diprospan, which block inflammation as much as possible and accelerate healing.

Surgery

According to indications, including the size of the seroma and the nature of its manifestation, surgical treatment may be prescribed. It includes:

1. Punctures. In this case, the doctor removes the contents of the resulting cavity with a syringe. The positive aspects of such manipulations are as follows:

can be performed on an outpatient basis;
painlessness of the procedure.

The disadvantage is that the puncture will have to be done more than once, and not even twice, but up to 7 times. In some cases, it is necessary to perform up to 15 punctures before the tissue structure is restored.

2. Installation of drainage. This method is used for seromas that are too large in area. When drainage is placed, patients are simultaneously prescribed antibiotics.

Folk remedies

It is important to know that regardless of the reasons for the seroma of the postoperative suture, this complication is not treated with folk remedies.

But at home, you can perform a number of actions that promote healing of the suture and prevent suppuration. These include:

lubricating the seam with antiseptic agents that do not contain alcohol (“Fukorcin”, “Betadine”);
application of ointments (Levosin, Vulnuzan, Kontraktubeks and others);
inclusion of vitamins in the diet.

If suppuration appears in the suture area, you need to treat it with antiseptic and alcohol-containing agents, for example, iodine. In addition, in these cases, antibiotics and anti-inflammatory drugs are prescribed.

In order to speed up the healing of stitches, traditional medicine recommends making compresses with an alcohol tincture of larkspur. Only the roots of this herb are suitable for its preparation. They are washed well from the soil, crushed in a meat grinder, put in a jar and filled with vodka. The tincture is ready for use after 15 days. For a compress, you need to dilute it with water 1:1 so that the skin does not get burned.

There are many folk remedies for wound healing and surgery. Among them are sea buckthorn oil, rosehip oil, mumiyo, beeswax, melted with olive oil. These products should be applied to gauze and applied to the scar or seam.

Postoperative suture seroma after cesarean section

Complications in women whose obstetrics were performed by caesarean section are common. One of the reasons for this phenomenon is the mother’s body, weakened by pregnancy, and unable to ensure rapid regeneration of damaged tissues. In addition to seroma, a ligature fistula or keloid scar may occur, and in the worst case scenario, suppuration of the suture or sepsis. Seroma in women giving birth after a cesarean section is characterized by the fact that a small dense ball with exudate (lymph) inside appears on the suture. The reason for this is damaged blood vessels at the site of the incision. As a rule, it does not cause concern. Seroma of 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 speed up its healing.

Complications

Postoperative suture seroma does not always go away on its own and not in everyone. In many cases, without a course of therapy, it can fester. This complication can be provoked by chronic diseases (for example, tonsillitis or sinusitis), in which pathogenic microorganisms penetrate through the lymph vessels into the cavity formed after surgery. And the liquid that collects there is an ideal substrate for their reproduction.

Another unpleasant consequence of seroma, which was not paid attention to, is that it does not fuse with muscle tissue, that is, the cavity is constantly present. This leads to abnormal skin mobility and tissue deformation. In such cases, repeated surgery must be used.

Prevention

On the part of the medical staff, preventive measures consist of strict adherence to the surgical rules of the operation. Doctors try to perform electrocoagulation more gently and injure less tissue.

On the part of patients, preventive measures should be as follows:

Do not agree to surgery (unless there is an urgent need) until the thickness of the subcutaneous fat reaches 50 mm or more. This means that you first need to do liposuction, and after 3 months, surgery.
After surgery, wear high-quality compression stockings.
Avoid physical activity for at least 3 weeks after surgery.

Every year, more and more women turn to surgeons to perform breast augmentation or plastic surgery operations.

But not every representative of the fairer sex knows about the possible appearance of seroma after breast surgery. Statistics show that seroma occurs in 15% of patients who have undergone breast surgery.

Seroma is a complication caused by surgical intervention, manifested by the accumulation of serous fluid. With this pathology, fluid accumulates inside the mammary gland, which stretches it. A woman's breasts sag.

Development factors

The most common occurrence of seroma is observed:

· when using large implants in the case of plastic surgery;

· when performing major operations accompanied by high trauma (for example, radical mastectomy performed for breast cancer).

Experts identify a number of predisposing factors for the development of seroma after breast surgery.

1. Individual reaction of the body to the used endoprosthesis. Any type of implant is a foreign body for the female body, so many women may experience an accumulation of serous fluid. In the normal condition of the patient, any consequences are short-term and disappear within a week, but with individual intolerance to the material used in the manufacture of the implant, some experience the formation of scar tissue in the mammary gland.

2. Squeezing of soft tissues - with a large mechanical impact on soft tissues, lymph outflow is disrupted. Therefore, it subsequently begins to accumulate, gradually transforming into serous fluid.

3. Damage to lymph nodes. If blood vessels, especially lymphatic ones, were damaged during surgery, the risk of seroma increases significantly.

4. Increased tissue bleeding. There are many blood vessels in the mammary gland and if they are damaged, blood can enter the breast tissue and transform into serous fluid.

5. Hematoma. When the hematoma resolves, a large amount of “ichor” accumulates in the soft tissues of the mammary gland, which is converted into serous fluid.

6. Poor drainage. During any surgical intervention, lymph is released and if it is not removed in a timely manner, there is a risk of developing pathology. Especially a lot of lymphatic fluid is released during operations for cancer.

7. Individual intolerance to suture material. For the operation, high-quality threads are used to connect the wound, but some women may develop an allergy to the suture material. In response to this, the body produces serous fluid - a seroma is formed.

In addition, predisposing factors for the development of seroma include the presence of various chronic pathologies: diabetes mellitus, hypertension, obesity, etc. To avoid the development of seroma after breast surgery, a woman should regularly visit a mammologist. Only a doctor will be able to timely determine the initial stages of this process and prescribe appropriate therapy.

Symptoms

According to statistics, seroma occurs only after breast surgery. Therefore, a woman is advised to closely monitor the healing of postoperative sutures, and also pay attention to any symptoms that appear. Thus, the development of seroma is accompanied by specific symptoms:

· breast deformation. There is an unnatural increase or change in the shape of the breast, which is easily diagnosed even with a visual examination;

· swelling of the chest. Serous fluid can become trapped in the soft tissue of the breast, and many patients experience breast swelling;

· discomfort and pain in the breast area. Most girls experience pain when touching their breasts;

· hyperemia of the epithelium, or redness of the skin (in simple terms). When serous fluid stagnates, a woman’s blood vessels experience great pressure, causing the destruction of capillaries. As a result, the skin may turn red;

· the appearance of fluid in the suture area is a rare sign, but is still observed in 10% of girls who experience seroma.

If such signs are present, it is recommended to immediately visit a specialist (mammologist). The doctor will examine the patient and make an accurate diagnosis, on the basis of which he will be able to choose the most rational treatment tactics.

Possible consequences

Most girls and women believe that seroma is a harmless pathology that goes away on its own. This opinion is partly true, but sometimes inattention to one’s health provokes the appearance of serious pathologies:

· formation of a serous fistula - serous fluid is released through postoperative sutures. In addition, in the case of plastic surgery, infection of the implant is observed;

· the development of capsular contracture is a pathological process that provokes an increase in soft tissues that gradually form a capsule. Externally, this greatly disfigures the skin;

· suppuration in the area where the implant is placed - when fluid stagnates, the inflamed area of the breast becomes vulnerable to “attacks” of pathogenic microorganisms.

Diagnostic measures

If you suspect the development of seroma after breast surgery, a woman should immediately visit a specialist. The attending physician will conduct a visual examination of the patient’s breasts and may prescribe additional examinations:

· Ultrasound - allows you to identify any changes in the operated area;

· X-ray mammography - is carried out to determine the condition of the mammary glands, as well as to identify any lumps in the mammary gland (the examination is prescribed for women aged 40 years and for patients after surgery);

· MRI - allows you to monitor the condition of installed implants, as well as identify the appearance of any deviations at an early stage.

Treatment

Statistics show that in 90% of cases of seroma development after breast surgery, the pathology goes away on its own within 5-20 days, but sometimes this does not happen and more dangerous consequences begin to develop (primarily purulent-inflammatory). With severe stagnation of fluid, the patient needs specialized treatment. In modern times, seroma is treated in two ways:

· vacuum aspiration;

· use of drainage.

Vacuum aspiration

Vacuum aspiration has been actively used in the treatment of stagnation of serous fluid for many years. The disadvantages of such treatment include the fact that it is effective only in the early stages of the onset of pathology.

When carrying out vacuum aspiration, a device with an attached hose is used. This tube is inserted into the area of stagnation of liquid and it is “sucked out” using vacuum (negative pressure created by an aspirator).

When using this method of treatment, doctors do not have to open the wound again. In addition, this operation helps in the healing of sutures placed at the end of breast surgery. Many experts recommend performing vacuum aspiration not only in the treatment of seroma, but also for preventive purposes immediately after surgery, especially if it was performed for breast cancer.

Application of drainage

Another popular method of treating seroma is drainage. This method of therapy can be used regardless of the stage of development of the pathology. This is the main advantage compared to vacuum aspiration.

During drainage, all accumulated fluid comes out using the installed drainage. In order not to provoke any dangerous consequences, it is better to use disposable sterile drainages. If the clinic does not have this opportunity, then the drainage tubes must be thoroughly sterilized and disinfected. Such measures reduce the risk of inflammatory complications.

All manipulations can be carried out through the sutures left after surgery, or a special puncture, which is made immediately before drainage. After inserting the drainage, it is fixed with sutures and left for several days, during which the area of accumulation of serous fluid and the sutures are treated with a solution of brilliant green.

A rubber or silicone drainage tube is currently used to pump out serous fluid. They practically do not interfere with the patient’s active lifestyle (its activity, of course, corresponds to the postoperative period). To ensure that the liquid flows out well, a medical bulb is connected to the outer end of the tube. It creates negative pressure, so the serosa is constantly “sucked out”.

Since the serous fluid has high viscosity, the patient should be in a horizontal position and preferably on her back. This is necessary so that the patient can independently care for the drainage tube. All manipulations are carried out directly under the supervision of medical professionals; doing any manipulations on your own initiative is strictly prohibited.

Preventive actions

To reduce the risk of developing seroma after breast surgery, experts recommend adhering to certain rules:

· refuse plastic surgery if the thickness of subcutaneous fat in the operated area exceeds 5 cm (before this, it is necessary to reduce weight);

· before the sutures heal, they must be treated with a special disinfectant solution, and postoperative dressings must be changed daily;

· the patient must monitor the sterility of the wound and regularly visit a specialist who will monitor the healing process and identify the slightest signs of deviation from the norm;

· in order to avoid the accumulation of serous fluid, it is recommended to install special bags with weights on the postoperative suture (they compress the vessels, therefore reducing the percentage of fluid perspiration);

· within 2 months after surgery, the patient must wear compression garments or a bandage;

· normalize your diet and include protein foods, as well as fruits and vegetables, in your menu. This will strengthen the immune system and normalize its functionality;

· exclude the consumption of unhealthy foods (alcoholic drinks, sweets, fatty and spicy foods);

· make sure that the wound is completely sutured and does not have any pockets through which pathogenic microorganisms can enter the body and cause an inflammatory process;

· spend more time in the fresh air;

· normalize your daily routine. A woman should have proper rest and sleep at least 7 hours a day.

The development of seroma after breast surgery is by no means a harmless phenomenon, and if left untreated, it can provoke the appearance of dangerous pathologies. That is why you should not neglect your health, and if the patient shows signs of accumulation of serous fluid, you should immediately seek medical help. Only a doctor can make an accurate diagnosis and select an effective method of treating this pathological process.

Serous fluid appears in the human body as a result of natural processes in the body. It looks like straw-colored moisture. The viscosity level of this exudate depends on the balance of fractions that are formed during the filtration process of the liquid in the blood vessels.

Serous fluid consists of two fractions: liquid and formed elements. The latter includes protein, leukocytes, mesothelium and other elements.

Excess serous fluid in the human body appears in cases where there is a malfunction in the functioning of the circulatory and lymphatic systems. This condition is most often observed after any surgical intervention. It's called seroma.

Signs of seroma

The main symptom indicating the accumulation of fluid in the tissues is an increase in the size of the area where surgery was performed. Most often, this symptom appears after operations to pump out subcutaneous fat and install breast implants. Moreover, during liposuction, serous fluid begins to accumulate not so much in the tissues as in the voids formed after pumping out the fat.

During implantation, fluid accumulates mainly between the implant and living tissues. In this case, the appearance of seromas is a sure sign of implant rejection.

The development of seroma can also be identified by the following signs:

The postoperative scar becomes swollen.
When palpating the area around the sutured wound, the patient experiences discomfort.
Pain may appear without pressing on the swollen area.
In the later stages of seroma, the pain can become very severe and take on the character of colic.
The skin in the area of surgery becomes red. Sometimes there is a local increase in tissue temperature. True, if moderate amounts of fluid are released through the postoperative suture, then hyperemia and hyperthermia may not occur.

By the way, stitches after operations get wet quite rarely, and the appearance of moisture always indicates the development of severe seroma. If treatment of the pathology is not started in time, a fistula may form, allowing serous fluid to drain out.

The appearance of postoperative seroma is most often associated with a large area of surgical intervention, which resulted in detachment of the subcutaneous tissue. Due to the rough impact, tissues begin to bleed and break down under the influence of enzymes. All this provokes the appearance of seroma.

Serous exudate after surgery appears mainly from damaged lymphatic vessels, since they, unlike blood vessels, are not capable of rapid healing. It takes at least a day for the lymphatic vessel to heal. It turns out that the more damage the lymphatic network received, the more serous transudate will be released.

Another reason for the appearance of seroma after surgery is increased bleeding. This occurs in cases where insufficient attention was paid to blood clotting during preoperative preparation.

Upon completion of the operation, blood continues to flow into the suture area through numerous capillaries. These small hemorrhages resolve fairly quickly, leaving behind a serous exudate.

Also, the cause of the development of seroma can be a postoperative hematoma. Its source is not small, but large blood vessels. When they are damaged, bruises always appear.

In such situations, seroma is detected in the patient no earlier than 5 days after surgery. This period is determined by the rate of resorption of the hematoma with the formation of serous fluid. In fact, for this reason, after operations such as cesarean section and abdominoplasty, surgeons must closely monitor the patient’s condition for at least 5 days. Their main task is to promptly identify the appearance of small bruises.

The cause of the appearance of serous exudate may be rejection of the implant installed during surgery. Some people's bodies are very sensitive to various foreign elements. For this reason, implant manufacturers strive to make them from biologically inert materials in order to minimize the risks of possible complications. Unfortunately, even the use of the most modern implants does not guarantee that they will take root normally in the patient’s body. Implantation operations are always a risk that people consciously take.

Finally, seroma does not always occur at the surgical site. It can appear at the site of a severe bruise or dog bite. The reason is crushing of tissues due to mechanical impact. Destroyed cells are utilized with the release of serous fluid.

Factors contributing to the appearance of seroma

In the postoperative area it increases under the influence of certain factors. These include:

To eliminate or minimize the impact of these factors, doctors conduct a thorough examination of the patient before surgery, study his blood for sugar, and determine the rate of clotting . Treatment is provided if necessary.

Diagnosis of pathology

Seroma goes through stages of its development very quickly. In order not to start the disease, it must be detected in a timely manner.

To identify this pathology, the following diagnostics are used:

Visual inspection. The surgeon's responsibilities include daily inspection of the patient's wound. If undesirable changes in the scar are detected, the doctor may perform palpation. If he feels fluid flowing under his fingers, he will prescribe an additional examination.
Ultrasound examination of the surgical area. It allows you to confirm or refute the presence of fluid in the postoperative suture area.

It is extremely rare that a puncture is performed if a gray tumor is suspected. It is mainly needed to determine the qualitative composition of serous exudate. Based on these data, treatment tactics are subsequently developed.

Treatment of pathology

Serous fluid under the surgical suture may persist for a long time, but in most cases it disappears by 20 days after surgery. The timing of disappearance strongly depends on the nature of the surgical intervention, its complexity and the area of the wound surface. All this time, the doctor must closely monitor the development of seroma.

Treatment of pathology begins if there is too much moisture under the skin and there is a serious risk of developing an inflammatory process or sepsis. The essence of treatment is to remove exudate from under the skin. This is done in various ways.

Vacuum aspiration

This method of treating seroma is used most often. It allows you to get rid of exudate in the early stages of the development of pathology that is not complicated by the inflammatory process.

The doctor makes a small incision in the area where moisture accumulates, into which a suction tube is inserted. After turning on the vacuum device, the moisture accumulated under the skin is mechanically removed.

Using the vacuum aspiration method can significantly speed up the healing of a postoperative wound. In addition, after the procedure, patients note a significant improvement in their well-being.

The main disadvantage of this technique is possible relapses. The fact is that vacuum aspiration only removes exudate, but does not eliminate the cause of its appearance. For this reason, after vacuum aspiration, doctors begin to eliminate the factors influencing the appearance of serous exudate under the postoperative suture.

Subcutaneous drainage

This is a surgical method for treating seroma of a postoperative scar. Its main difference from the vacuum aspiration method is that the doctor does not use special equipment.

Drainage involves removing serous fluid by gravity. To do this, a puncture is made in the area where exudate accumulates, through which a drainage system is inserted under the skin. Its outer part is connected to a collection of withdrawn biological material. After this, the exudate will be drained from under the skin immediately after its appearance.

All drainage systems are used only once. After completing the assigned tasks, they are removed and disposed of. Sterilization and reuse of drainage systems is not permitted.

Drug treatment

To prevent septic complications Doctors, while removing exudate, prescribe anti-inflammatory and antibacterial therapy to patients. It consists of the following drugs:

Broad-spectrum antibiotics.
Non-steroidal anti-inflammatory drugs: Naproxen, Meloxicam, etc. They can significantly reduce the volume of transudate.
Steroidal anti-inflammatory drugs. They are used in cases where it is necessary to quickly eliminate the inflammation that has arisen. As a rule, drugs such as Kenagol and Diprospan are prescribed.

To speed up the healing of postoperative wounds, ointments for external use are prescribed. Usually this is Vishnevsky ointment or Levomekol. They are applied to the skin in the surgical area 3 times a day.

Drug therapy can be combined with traditional medicine. Basically, folk recipes involve applying compresses with larkspur tincture, sea buckthorn oil, mummy and beeswax to the suture area.

Seroma after cesarean section

Mothers in labor encounter this pathology quite often. This is explained by the depletion of the body’s internal resources during pregnancy. It becomes incapable of rapid tissue regeneration. Seroma in women in labor often leads to the development of complications such as ligature fistula and suppuration of the suture. In some cases, the inflammatory process goes inward and affects the pelvic organs.

Initially, seroma in women who have undergone a cesarean section appears in the form of a small ball with exudate in the suture area. It does not cause concern and can resolve without any treatment. But if the compaction area increases in size, then immediate treatment is required.

Prevention of pathology

The appearance of seroma can be prevented, and this is not difficult to do. The main thing is to strictly follow the recommendations of your doctor.

Moderate appearance of serous exudate should not be considered as seroma. This is normal after surgery. Moisture secretion will stop within the first week. But if the exudate is released intensively, it is necessary to draw the attention of the attending physician to this fact so that he can prescribe treatment.

Any surgical intervention is dangerous due to possible complications. Such, for example, as seroma after breast surgery.

This is a postoperative condition, which is expressed in the accumulation of lymph or blood serum in the tissues of the operated area. It looks like a formed swelling, similar to a “bump”.

Seroma is not life-threatening. Doctors tend to consider it just a small problem among the many that occur after surgery. Timely measures can eliminate this problem in a few days. Moreover, seroma sometimes resolves on its own. But while it exists, a person experiences malaise, discomfort and inconvenience.

Therefore, the accumulation of fluid in tissues cannot be ignored. It is important that in an advanced state it can cause more serious complications, including sepsis.

Common causes of postoperative seroma formation are:

excess body weight;
advanced age;
history of diabetes and hypertension.

As it turned out, factors such as:

Individual intolerance the material from which the breast implant is made. Breast endoprostheses are made from high-quality biomaterials, however, in some cases they can cause a rejection reaction, which is accompanied by inflammation and causes the formation of seroma.
Extensive damage to lymphatic vessels during surgery and, as a consequence, a long recovery process. In such cases, the risk of fluid accumulation in the operated area increases.
The occurrence of a large hematoma, triggering the accumulation of ichor in the soft tissues, which can soon lead to the formation of a seroma.
Lack of drainage, which is usually installed without fail during breast surgery. Lymph accumulates, but there is no outflow. Fluid fills the internal space between the breast tissues, forming a complication.
Allergic reaction to suture materials(absorbable surgical sutures). This happens especially often if the surgical area is quite large and a large number of suture threads are used.

Mechanism of seroma development

The forming seroma makes itself felt already on the third day after surgery:

there are sensations of painful squeezing under postoperative sutures;
there is a feeling of fullness in the area that was operated on;
an inflammatory process develops, accompanied by an increase in temperature;
the mammary gland swells, enlarges, and may slightly change shape; the formation of a “bump” under the skin becomes noticeable;
the skin itself at the site of fluid accumulation and on the postoperative scar becomes painful, red, sometimes with a bluish tint; Light pressure on the scar can cause serous discharge to flow.

These are the symptoms of seroma, but in order not to make a mistake in the diagnosis, doctors conduct additional examination.

How is seroma formed?

The process of seroma formation is explained by the following reasons:

Accumulation of separated blood serum. This happens when a seroma forms from a hematoma.
Leakage from vessels and capillaries, which occurs due to strong compression of tissue during surgery or due to “leaky” blood vessels. Microscopic ruptures prevent the vessels from retaining serum.
Damage and/or cell death. This circumstance provokes an inflammatory process, as a result of which serum accumulates in the mammary glands.

Diagnostics

An important stage in the diagnosis of seroma is hardware research, namely:

Ultrasound of the mammary glands, allowing you to notice the complication at the very beginning of development. In this way, all changes after mammoplasty operations are monitored. Ultrasound gives a complete picture of the size of the seroma, the location and stage of its formation.
Magnetic resonance imaging. Its advantage is the high accuracy of the results and the complete absence of radiation.
X-ray mammography. It is not usually used on women under 40, but everyone gets a mammogram after breast surgery. This type of examination allows not only to determine the condition of the breast as a whole and to see areas of fluid accumulation, but also to detect tumors in a timely manner.

After the age of 45-50, a woman’s breasts undergo involutional changes. amenable to surgical correction.

How does ultrasound of the mammary glands differ from mammography, read.

Osteochondrosis of the thoracic region can manifest itself as pain in the mammary gland. We'll tell you how to recognize the disease.

Treatment and prevention

Treatment and prevention of seroma formation are as important as with any other pathology. They are clinically tested and widely used in practice.

Treatment with antibiotics

In cases where the accumulation of serous fluid is small in size, broad-spectrum antibacterial drugs, which are prescribed along with anti-inflammatory drugs, help get rid of the problem.

However, drug treatment is not always applicable.

If the seroma is of impressive size and does not go away on its own, then you can get rid of it in two ways, which are based on the concept of removing fluid. If necessary, these methods are successfully combined with antibiotics.

Vacuum aspiration

The fluid is drawn out by vacuum through a device that is connected to the bottom of the seroma. In this case, the old surgical wound is not opened.

The vacuum aspiration method allows you to accelerate the healing of damaged tissues from which the fluid has been pumped out. Thus, the postoperative recovery period is faster and easier.

Using drainage

The drainage method is used for both prevention and elimination of seroma.

It is applicable at any stage of this complication. Disposable sterile drainage tubes use a special apparatus to pump out and remove the accumulated fluid.

Installation of drainage is possible either through an old surgical suture or through a small puncture. The tube insertion site and the skin around it are treated daily with disinfectant solutions and a sterile bandage is applied.

Sometimes it is possible to prevent the formation of seroma with a special massage - gentle pressure with your hand on the operated area of the body, which eliminates the impact on the scar. The attending physician must be trained in this manipulation, otherwise there is a risk of divergence of the wound edges.

Speaking about the prevention of seroma, it is important to note that it consists of three stages:

Preoperative. Includes the collection of necessary information about your health status based on medical tests, ultrasound, ECG and consultations with specialists (necessarily a surgeon and gynecologist).
Intraoperative. It is performed by a surgeon who is responsible for the quality and safety of the operation, including the correct distribution and installation of drainage, as well as the use of suitable suture material. Special mention should be made about drainage. It is installed during surgery and removed after a few days when the outflow of fluid stops. In some cases, after removal of the drainage tubes, there is still a risk of seroma, but this is very rare. Experts say that even if seroma forms again, it will be much smaller than before.
Postoperative. It consists of following all the rules established for the postoperative period. This applies to regular visits to the doctor, following all his prescriptions and recommendations, wearing special underwear, avoiding heavy physical activity and giving up bad habits.

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Seroma is a cavity with serous fluid that forms in the area of a postoperative suture or after severe injury to soft tissues and blood vessels. It is not dangerous, often resolves on its own, but often requires therapy.

The first symptom of seroma is redness of the area around the suture and swelling, and the release of yellowish fluid along the edges of the wound. Additionally, the body temperature may rise, the patient is bothered by severe pain and a feeling of fullness and heaviness.

Treatment of seroma is carried out with medications or through the installation of drainage and vacuum aspiration. When diagnosing the problem early, it is advisable to use folk remedies - aloe compresses, bran and honey cakes, cabbage leaves.

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Characteristics of seroma: what it is, what it looks like, color of the liquid

Seroma is a formation located in the tissue of the subcutaneous cavity; it looks like suppuration due to the color of the accumulated fluid: it can vary from yellow to gray and have miniature blood streaks. Most often, seroma forms in postoperative sutures, and this is always associated with the negligence of doctors and violation of sterility.

IBC code 10

There is no separate code according to MBC 10 for this pathological condition; doctors indicate it taking into account the type of operation performed and the cause of the seroma. For example, if this happened after a cesarean section, then the medical record will indicate “0 86.0”, and this is interpreted as “suppuration of a postoperative wound and/or infiltration in its area.”

How long can it be, why is it dangerous?

Seroma is an early postoperative complication; it usually does not persist for a long time - within 8-14 days the formation, with adequate therapy, disappears, but in some cases it can persist for one and a half to two months.

Doctors claim that the fluid accumulated in the subcutaneous cavity does not pose a threat to the patient’s health/life. But if the seroma is extensive, there is too much content, then more serious complications may develop - necrosis of surrounding tissues, sepsis, too long wound healing.

People at risk of fluid accumulation after surgery

When planning a surgical intervention, doctors take into account all the patient’s health characteristics in order to identify in advance the likelihood of developing seroma; this risk group after surgery includes patients with previously diagnosed:

diabetes mellitus;
hypertension;
obesity.

This list also includes patients from older age groups whose regeneration and recovery capabilities are at a very low level. It is noted that seroma is most often diagnosed in women, because a similar complication occurs after a cesarean section, mastectomy, or abdominoplasty.

Can it resolve?

In most cases, early postoperative seroma resolves within the first 3-5 days of the rehabilitation period. As a rule, the patient is under the control of medical workers during this period, so the seroma does not develop into an advanced state. It will not resolve on its own; drug therapy or additional surgical intervention will be required.

Postoperative seroma

The pathological formation in question may be small in size and not manifest itself at all for a long time, but in a certain period of time (for example, if the immune system sharply weakens, a general infectious disease develops, and so on), both inflammation and intoxication will certainly appear. If immediately after surgery seroma can be successfully treated with medication, then in advanced cases only surgery will solve the problem.

Why is yellow liquid dangerous?

The yellow liquid is not dangerous, but only until its amount begins to increase. After all, it is the “content” of the lymphatic system, which is constantly replenished. And if no therapeutic measures are taken, the patient’s well-being will worsen, complaints of a feeling of fullness and pain in the area of seroma formation will appear. In fact, the doctor will reveal:

skin redness;
swelling of the site of pathological accumulation of fluid;
increase in general body temperature to subfebrile levels.

These are signs of incipient inflammation of the skin and soft tissues surrounding the seroma. The danger is that this pathological process can rapidly progress, which leads to necrosis of the skin flap, the spread of inflammation, the introduction of an infectious agent into the cavity and sepsis.

Why does serous fluid appear?

Serous fluid usually appears for two main reasons:

Fat deposits. During the operation, they peel off from the skin, resulting in the formation of cavities in which lymphatic fluid accumulates. It is believed that the presence of a large fat layer in a patient (more than 50 mm) is a reason for intensive weight loss before surgery or preliminary liposuction.
The wound surface area is too large. It's simple: in this case, damage occurs to a large number of lymphatic vessels, which heal much more slowly than blood vessels. During the entire healing process, liquid oozes out of them, which accumulates in the cavities.

Seroma after surgery

But doctors also consider “individual” reasons for the formation of seroma, depending on the nature of the injury.

Like post-traumatic, shin after injury

Post-traumatic seroma - for example, one that appears on the lower leg after an injury, is formed against the background of severe compression of tissue. It can be short-term, but at this time there is a deterioration or complete stop of lymph flow through the vessels. After medical assistance is provided, lymph rushes through the vessels with great force, so it immediately enters the tissues in large quantities.

Usually, after such injuries, seroma is immediately diagnosed in an advanced form. The reason for this is precisely the too large volume of lymphatic fluid poured into the cavity.

After breast surgery: mammoplasty, mastectomy

Seroma often occurs after breast surgery (mammoplasty, mastectomy), and the reason for this is simple - the mammary gland anatomically consists of glandular and fatty tissue, and the operation involves making large/extensive incisions that damage not only blood vessels, but also lymphatic vessels. The result is the accumulation of serous fluid under the skin already in the recovery period.

If the doctor suspects an acute inflammatory process in the soft tissues, an ultrasound examination will be prescribed.

Treatment of postoperative suture seroma

Treatment for seroma is selected depending on the severity of the pathological process and the results of the diagnosis. Drug therapy or repeated surgery may be used. If the pathology was diagnosed at the very beginning of its development, then it is advisable to use folk remedies, but only after consultation with the attending physician.

How to pump out with drainage

Serous fluid is pumped out from the seroma using drainage as follows:

The entire system is replaced and the wound is treated with antiseptic treatment no more than once every 2-3 days. This is what makes this method of treating seroma not the most appropriate - during the period between dressings, both infectious agents and pathogenic microorganisms can penetrate into the open cavity. This will provoke expansion and worsening of the inflammatory process.

Therefore, instead of rubber drainage, modern medicine prefers to use special tubes. The receiver where the liquid flows must contain an antiseptic solution.

Most often, removal of seroma with a drainage system is used if the fluid has accumulated again, although in the recent past it was completely removed from the cavity.

How to remove by vacuum aspiration

Vacuum aspiration is used to remove gray as follows:

The patient is given local anesthesia. These are injections of painkillers, if there are no contraindications to such manipulation.
The surgeon uses an instrument to make a small incision in the area of the formed seroma.
A tube is inserted into the resulting cavity, to which a vacuum suction apparatus is connected.

Removal of liquid continues until its color changes from yellow to ichor. The doctor immediately removes the entire system and closes the wound with sterile suture material. A sterile bandage is applied on top.

The duration of the vacuum aspiration procedure is a maximum of 30 minutes. It is advisable to perform it if the accumulation of fluid has just begun, and there are no pronounced signs of seroma yet. Healing of the suture after manipulation proceeds 2 times faster.

Ointment for home treatment

For treatment at home, you can use ointments with anti-inflammatory, decongestant and analgesic effects. But such therapy should still be carried out only under the supervision of a doctor - it is necessary to monitor the dynamics of the disease in order to avoid full-fledged surgical intervention in case of acute progression of the pathological process.

The following ointments can be used to treat seroma:

Naproxen is a gel that is applied to the skin around the stitch at least 3 times a day;
Ketoprofen - used as standard around the suture, can be applied to all swelling at least 2 times a day.

If seroma was diagnosed at an early stage of formation, and ointments began to be used immediately, then already on the 3rd day of such therapy the patient will notice a significant improvement in well-being - the pain will no longer bother you, the feeling of heaviness will disappear, the swelling of the skin will become less pronounced, and the redness will almost disappear. The usual duration of ointment therapy is 5-7 days.

Antibiotics

Antibiotics in the treatment of seroma are used only if the pathology is already advanced, and during diagnostic measures pathogenic bacteria were identified in the serous fluid. In this case, it is advisable to prescribe:

Erythromycin - available in tablets, belongs to the group of broad-spectrum antibiotics, taken 1 tablet 2-3 times a day;
Cefotaxime, Ceftibuten and other drugs from the cephalosporin group are used as tablets or solutions for intramuscular administration.

Modern medicine also carries out the manipulation of introducing a solution of antibacterial drugs directly into the cavity of the seroma. This procedure is advisable if during diagnosis a high level of pathogenic microorganisms in the serous fluid was detected.

In general, antibacterial therapy lasts at least 5 days, but a significant improvement in the patient’s well-being and the condition of the postoperative suture is noted already on the 3rd day. In any case, doctors do not recommend interrupting treatment to avoid a recurrent pathological process.

Folk remedies

Folk remedies cannot be considered full-fledged therapeutic, but after consultation with a doctor they can be used as additional therapy. If therapy is carried out exclusively by traditional medicine methods, then it is necessary to strictly monitor the state of health, well-being and appearance of the suture. In case of deterioration, immediately stop using folk remedies and seek qualified medical help.

Aloe for compress

Take 3 leaves of the plant - from the very bottom of the bush, they should be “fleshy”. They are ground in a blender or through a meat grinder into a paste and squeezed well. The remaining “cake” is placed on a bandage and applied to the postoperative wound with seroma in the form of a compress - parchment paper and polyethylene are laid on top and the pathological focus is insulated. Aloe juice is taken orally, 1 teaspoon before meals (10-15 minutes).

Flatbread

Prepared from bran and honey, the products are taken in proportions such that the “output” is a viscous mass. It is formed with your hands into a cake (not dense) and applied to the problem area. They don’t cover anything on top, they don’t bandage it. The time such a cake spends on the serome is 1 hour. You need to perform 2-3 procedures per day.

Already on the 2nd day of manipulation, the swelling will disappear and the redness will become less pronounced.

What is possible for a postoperative suture after a cesarean section?

If a seroma has formed on a postoperative cesarean section suture, then the question of drug therapy is the last thing doctors raise. Such caution is due to the fact that the woman in labor is breastfeeding, and taking antibiotics and corticosteroids is strictly contraindicated for her.

Therefore, just after a caesarean section, it is worth resorting to folk remedies, if the seroma is not extensive and doctors do not insist on installing a drainage system or performing vacuum aspiration.

Recovery after treatment

After seroma treatment, recovery is carried out in a standard manner:

change drainage once every 2-3 days, then completely abandon it;
intramuscular injections of antibacterial drugs to prevent the progression of the inflammatory process;
if necessary, take painkillers.

If the seroma is removed on time, the postoperative suture heals quickly, and the patient is discharged in the standard manner - on the 10th day after surgery.

Prevention of seroma of the chest, pelvis, and abdominal cavity

To exclude the formation of seroma in the chest, pelvis, and abdominal cavity, doctors carry out a number of preventive measures:

A weight is placed on the postoperative suture (immediately after the end of the surgical intervention). These could be sandbags or a heating pad with ice.
The surgical wound is not immediately sutured, leaving a hole for installing a drainage system.
Conducting antibacterial therapy in the early postoperative period.
Refusal for a patient to undergo abdominoplasty if the subcutaneous fat layer is too large.
The use of electrocoagulation is targeted, affecting only blood vessels without tension on soft tissues.
Wearing high-quality compression garments in the early and late postoperative periods.
Avoid physical activity for 3 weeks after surgery.

Seroma is not considered a dangerous complication of the postoperative period, but requires monitoring by medical professionals and therapeutic measures. With proper treatment, the problem is solved within 5-7 days; in especially advanced cases, therapy can last up to 60 days and be accompanied by severe complications such as necrosis of the skin flap, sepsis, and infection of the surgical wound.

Useful video

Watch this video about the causes of seroma: