First a little education.
What is a seroma?
A seroma is a collection of fluid formed in the body. We see these after we do surgery where we create a space in the body. Your body reacts to injury by creating a host of healing and inflammatory factors to try to heal and close the space. This fluid is kind of a pink yellow clear fluid, we call serous fluid.
Why is a seroma a problem?
If fluid collects in the space, the tissue isn’t touching. If it isn’t touching it can’t seal together. If the fluid stays there long enough, it can form a rind, and then it won’t close down. To fix this can be difficult.
What do we do to prevent it?
The things we do to prevent seromas after tummy tuck surgery are to limit injury (to try to decrease the inflammatory fluid response) and to close down the space so the tissue heals together.
- quilting or progressive tension sutures (to seal down the space)
- drains (to suck the fluid out of the space, so the tissue is touching)
- lower setting on the cautery (to decrease thermal injury)
- leaving fascia (to preserve lymphatics and drainage)
- compression garments (to help seal down the space and prevent swelling)
- limiting activity (to allow the tissue to heal together)
- TXA (I have started using TXA in my tummy tucks, and have seen the fluid drainage decrease rapidly)
Even with doing all of these things, seromas can still be an issue. It isn’t a common one, but can be terribly tough to treat. I do all of these techniques, but it is not a guarantee. The quilting sutures made an enormous change in my patients, causing drainage to go from 2-3 weeks to 1. Then I added TXA and that lowered drain output even further. I haven’t been bold enough to go to no drain- I usually do a lot of liposuction to sculpt during the tummy tuck. But most of my patients now can get their drain out in one week or less. Most surgeons remove the drain when it is putting out less than 30cc in a day (your body is able to safely absorb that amount of fluid, so the fluid doesn’t accumulate.)
Read on to see journal article on triamcinolone and seroma rates.