What is Seroma: Symptoms, Treatment, Causes, Prognosis, Epidemiology, Pathophysiology, Prevention

Seroma is a common post-surgical complication which is marked by the onset of swelling at the surgical site. It occurs in the cases where the surgeries involve implanting of medical devices within the body or removal of large mass from the body. Structurally, seroma is a tissue in which fluid accumulation occurs. This fluid usually develops within the dead space of the tissue which is a consequence of the defense mechanism of the body in response to the tissue inflammation due to the surgery.

Seroma can be defined as the accumulation of sterile fluid within a restricted dead location of a tissue that underwent a surgical procedure. This process of accumulation of fluid is a normal bodily mechanism which occurs in response to cellular death of the tissue which once used to contain live blood vessels and capillaries. This further result in the inflammation of the dead tissue which increases the permeability of the vascular tissues that lies within. This increased permeability allows fluid buildup within the tissue. The fluid needs to be removed else it causes irritation in the affected area. When the fluid gets removed completely then the cavity might accumulate fibrotic tissue which may result in reabsorption of fluid. The amount of fluid accumulation depends on the size of the dead pocket. Smaller seroma accumulate less fluid and subside by itself, it may later form hard knots after undergoing calcification. On the other hand, the larger seroma need fluid removal as a treatment. Though seroma can develop at numerous places on the body but the common sites that are usually affected by seroma after surgery are abdomen, breast, axilla, neck, lumbar area, inguinal area and subcutaneous regions.

Seroma can be classified into various types depending on the type of surgical procedure performed. These types are:

• Seroma due to Infection: It is normally caused due to injuries and accidents through non-sterile equipment, which further leads to infection at the site thereby causing infectious seroma. This kind of seroma requires fluid draining as well as antibiotic therapy for treatment.
• Seroma due to Regular Surgery: This type of seroma occurs after a regular surgery in which the blood vessels get injured due to dissection. These are treated immediately to prevent enlargement of the dead cavity without any complications.
• Seroma due to Plastic surgery: Aesthetic surgeries related to face and tummy generally result in seroma.

The symptoms that arise due to seroma can be categorized on the basis of urgency for treatment. These are:

• General Symptoms of Seroma: The general symptoms that show up are:
  • Seepage of clear fluid from the surgical site.
  • Swelling and tenderness in and around the incision.
  • Warm on touch.
  • Reddish appearance.
• Symptoms that require Immediate Medical Intervention: The symptoms that require immediate attention are:
  • Pus formation and draining from the surgical incision.
  • Severe and persistent bleeding from the surgical site.
  • Extreme Pain.
  • Presence of high fever, greater than 101 degrees Fahrenheit.
  • Observable separation of the surgical wound.

Seroma incidence rate among the patient can range from three to eighty five percent with an average of twenty percent cases. The common occurrence of seroma is observed in patients who have had breast cancer related surgery or radiation therapy, a C-section or plastic surgery.

The outlook for seroma is great since these are generally not serious and with proper care and medical intervention heal quickly.

There is a whole great list of causes behind seroma as there are countless kinds of surgical procedures, but the most common causes are:

• C-section in Women as a Cause of Seroma: In contrast to normal delivery, this procedure may have certain complications like incorrect stitching of the layers of the body or improper incision that damages the blood vessels and the tissue around. The surgical procedure itself can also lead to accumulation of fluid and thus development of seroma.
• Mastectomy leading to Seroma: It involves removal of breasts from both the genders, usually in case of breast cancer. When the breast is removed it commonly results in seroma in the blood vessel at the surgical sites.
• Partial Breast Radiation Therapy as a Cause of Seroma Development: This breast cancer treatment involves exposure to concentrated ultra violet radiations that causes burns on the skin in vicinity. These burned areas later develop seroma.
• Seroma Caused Due to Reconstructive Surgery: The reconstruction surgeries especially involving the face is prone to the development of seroma due to several sensitive nodes and blood vessels being affected during surgery.

There is a lack of evidences suggesting the pathophysiology of seroma. Thus, uncertainty remains on how and why the process occurs but certain speculations suggest the secretion of the serous fluid occurs in the plasma form at the site of incision and accumulates within the scar tissue causing discomfort. This fluid is proteinaceous in nature and is secreted by serous glands like parotid gland. Thus, the accumulation of this fluid could be a cause of seroma.

The risk factors that pose a threat for seroma are:

• History of extensive surgery
• Presence of seroma after surgeries in the past.
• Excision of large amount of tissues after surgeries.

When seroma is not treated appropriately, then there are certain complications that can arise:

• Formation of abscess at the site of incision
• Formation of hard structures at the site of surgery due to calcification.
• Scarring of the surgical site.
• Surgical wound may open up.
• Occurrence of sepsis.

The diagnosis of seroma is mostly done through physical examination of the symptoms. Furthermore, imaging techniques like ultrasound and CT scan are done to check its presence and identify the proper location.

The treatment for small seroma is usually not required because in most cases it subsides by itself but in case of larger seroma below treatments can be taken up.

• Non-Surgical Treatments for Seroma: These treatments involve administration of antibiotic therapy to prevent infection. Also aspiration is required for draining the accumulated fluid. It is done by insertion of a surgical needle to draw out the fluid by puncturing the seroma.
• Surgical Treatments for Treating Seroma: When above measures fail to provide optimal relief and there exists a recurrent situation of seroma, then an open surgery is conducted to excise the seroma cavity. These samples are then checked for malignancies if any.

The preventive measures to check the development of seroma primarily involve setting of surgical drainage system to prevent accumulation of fluid. Also patients can put on medical garments that help in accelerated healing of the incision with reduced chances of seroma development.

Seroma is a commonly occurring medical condition that occurs after surgery at the site of surgical incision. It occurs as a defense response to the surgical trauma faced by the tissues which further results in dead pockets at the site of surgery. Seroma when small in size usually subsides itself and does not require any external medication or treatment but sometimes may get calcified. On the other hand the larger seroma, require immediate attention to prevent the chances of infection and further complications. These require draining of the accumulated fluid and in some cases surgical removal.