Seroma

A Seroma is characterized by a non-preformed tissue cavity filled with exudate. It can arise in wounds, injuries or inflammatory processes. In terms of differential diagnosis, however, it must be differentiated from abscesses and hematomas.

What is a seroma?

The seroma is a non-cystic cavity (pseudocyst) in the tissue filled with lymph fluid and serum. It occurs with injuries or inflammatory processes in the corresponding organs. These processes create tissue cavities that, unlike real cysts, are not lined with epithelium. In the case of a seroma, the pseudocysts are filled with exudate, which forms during inflammatory processes. It is lymph fluid with proteins, enzymes, glucose and other blood components.

If the exudate contains other cell components that are degraded by bacteria, pus develops. The accumulation of purulent exudate in the pseudocyst is called an abscess. When red blood cells accumulate, it is a hematoma. An unlimited spread of the pus causes the clinical picture of a phlegmon. If the exudate flows into other body cavities, it is called effusion. With a purulent exudate, empyema develops under these conditions. In contrast to a hematoma, a seroma remains painless when pressed on.

causes

Seromas usually appear on the surface of the skin. They can always form when inflammatory processes take place in the relevant tissue parts. Seromas also occasionally develop as a result of injuries and wounds. Inflammation caused by injuries or infections creates tissue cavities on the one hand due to dying tissue and on the other hand the serum fluid known as exudate.

During these processes, the hair vessels (tiny blood capillaries) become permeable for macromolecules and cells so that immune cells and hormones can reach the inflammation site. This is how the body tries to get rid of dead body cells and pathogens. Both abscesses and seromas can form. Seromas usually form on the surface of the skin and show up as painless swellings.

They often manifest themselves on closed skin wounds after an operation. Seromas are often caused by irritation caused by foreign bodies or by difficult lymph drainage in the wound area. They usually arise in large wounds and in disorders of protein metabolism.

Diseases with this symptom

• Wound healing disorders
• Empyema

Diagnosis & course

Seromas are characterized by skin swellings that do not change color and are usually insensitive to pressure. The accumulated fluid appears clear to cloudy-serous (serum fluid). It is also colorless to slightly yellowish. Seromas do not cause pain. This does not change even when pressure is applied to the swollen area. However, wound healing is hindered by a seroma.

Wound healing disorders occur even without infectious processes. However, a seroma can become infected even if it persists for a long time and serve as a starting point for further infections. However, smaller seromas usually heal on their own. Larger seromas should be punctured.

However, in order to properly treat seromas, they must first be diagnosed beyond doubt. In the differential diagnosis, the seroma must be differentiated from a hematoma and an abscess. Two main methods are used for diagnosis. This is on the one hand palpation and on the other hand sonography. Palpation is the manual examination of the patient.

The body structures are felt with one or more fingers or hands. In particular, the palpation is about the examination of the parameters size, elasticity, firmness, mobility and pain sensitivity of the examined body region. Palpation alone provides valuable information about the type of swelling. If the swelling remains colorless and is insensitive to pressure, an urgent suspicion of a seroma arises. The diagnosis can also be confirmed by sonography.

Complications

In most cases a seroma heals on its own and does not lead to further symptoms or complications. This is especially the case if the seroma is small and not particularly painful. However, if the seroma is large and painful, treatment should be carried out by a doctor. Inflammation or infection can develop on the seroma.

They usually slow down the process of wound healing and thus often lead to pain. It is not uncommon for patients to complain of reddened skin and itching. The person concerned should not scratch the skin under any circumstances, as this only increases the itchiness.

An inflammation in the seroma can spread to the neighboring areas of the skin and lead to swelling and wounds there too. If the seroma is not treated in time, it often leaves a scar on the skin. Whether this scar will disappear again cannot be universally predicted.

The slowed wound healing due to the seroma may prevent the patient from doing certain things as they are painful. In rare cases, the patient is then dependent on the help of other people. With timely treatment, however, a seroma can be removed and does not lead to any further symptoms.

When should you go to the doctor?

In most cases, small seromas heal on their own and do not cause any symptoms. If a large seroma is suspected, a doctor must be consulted. Anyone who notices an inflammation on the wound after an operation that may have already formed pus should discuss this with the attending physician. If left untreated, a seroma can impair wound healing and cause pain. Signs of a seroma are reddening of the wound and increasing itching.

If there are other symptoms such as fever or wounds, the seroma may have already spread to neighboring areas of the skin. Then a visit to the doctor is recommended to avoid a severe course and the formation of scars. Seromas in children, the elderly and patients with a skin disease must always be treated medically. This is especially true if the inflammation develops into a chronic problem. Severe secondary symptoms are rare, but if left untreated, a seroma can have a negative impact on general well-being and disrupt the healing of the original wound.

Doctors & therapists in your area

Treatment & Therapy

Treatment of seromas is individual and depends on their size and their potential to hinder wound healing. Smaller seromas usually heal on their own. In the case of larger swellings, the contents may have to be punctured sterile. A cannula is placed on the swollen area and the exudate is sucked off. A prerequisite for a properly performed puncture is sterile work in order to avoid infections. For this purpose, sufficient skin disinfection must be ensured at the puncture site.

If the seroma is extremely large and even painful, a so-called Redon drainage should be carried out for prophylaxis. The same applies to frequent recurrences. A Redon drainage is a suction drainage to drain off wound secretions. The secretion is directed to the outside in a closed system with a controlled suction. A thin plastic tube with multiple perforations at the end is attached to the body with a seam to prevent it from slipping out.

The exudate is sucked off by a continuously prevailing negative pressure and collected in a plastic bottle at the other end of the hose. The bottle is changed regularly to renew the negative pressure. During drainage it is imperative that the wound cavity is hermetically sealed from the outside. A redon usually lasts 48 to 72 hours. Redon drainage is usually necessary postoperatively after an extensive surgical procedure.

Outlook & forecast

As a rule, there is no pain or pressure discomfort with a seroma. However, the occurrence of the seroma greatly delays the healing of a wound. This can cause inflammation and infection on the wound itself, which ultimately lead to pain.

In most cases, no special treatment is necessary for a seroma and the seroma disappears on its own after a while. The doctor must then be seen when the seroma has become relatively large and is associated with pain. This usually results in a rash on the skin, reddening and severe itching on the affected area. The person concerned should avoid scratching the skin, as this only increases the seroma.

If the seroma is not treated properly, it can spread to an adjacent area on the skin and cause uncomfortable symptoms there as well. Treatment at the doctor is carried out with one procedure and does not cause any further discomfort. A seroma should be treated by a doctor, especially after operations, so that no further symptoms occur in the affected area.

prevention

Targeted prevention of a seroma is not possible. Redon drainage is only recommended as a prophylactic measure after extensive surgery following an injury or illness, in order to drain the wound secretion as quickly as possible. The use of this type of drainage is also recommended for recurring seromas. This can effectively prevent wound healing disorders.

You can do that yourself

A seroma is generally not seen as a hindrance in everyday life. However, a large-area seroma can lead to poor physical well-being. Affected areas in the head area in particular often have a visually daunting effect and then also cause psychological distress in those affected. The desire to treat it yourself is therefore very understandable. However, there is no scientifically proven effective method for self-treatment.

A wound dressing can be applied, which then has to be changed regularly. The wound must be cleaned with a disinfectant that can be purchased from the pharmacy. What should be avoided is scratching the affected areas. This could further spread and worsen the condition. A small seroma usually heals on its own.

If the seroma is extensive, a doctor should be consulted in any case. A doctor should also be consulted if the affected skin area is painful or extremely itchy. Even if there is no pain or itching, but the psychological distress prevails, doctors are usually available to help. The medical treatment options are straightforward and effective.