A seroma is characterized by a nonpreformed tissue cavity filled with exudate. It can occur in wounds, injuries, or inflammatory processes. However, it must be differentiated from abscesses and hematomas in terms of differential diagnosis.
What is a seroma?
Seromas usually occur on the surface of the skin. They can form whenever inflammatory processes take place in the corresponding tissue parts. A seroma is a noncystic cavity (pseudocyst) in the tissue filled with lymphatic fluid and serum. It occurs in case of injuries or inflammatory processes in the corresponding organs. These processes result in tissue cavities that, unlike true cysts, are not lined with epithelium. In a seroma, the pseudocysts are filled with an exudate that forms during inflammatory processes. This is lymph fluid containing proteins, enzymes, glucose and other blood components. If the exudate contains other cellular components that decompose due to bacteria, pus is formed. The accumulation of purulent exudate in the pseudocyst is called an abscess. If red blood cells accumulate, it is a hematoma. Unlimited spread of pus causes the clinical picture of phlegmon. If the exudate flows into other body cavities, it is called effusion. In the case of a purulent exudate, an empyema develops under these conditions. A seroma, unlike a hematoma, remains painless when pressed on.
Causes
Seromas usually occur on the surface of the skin. They can form whenever inflammatory processes take place in the corresponding tissue parts. Seromas also sometimes develop as a result of injuries and wounds. In the case of inflammation caused by injuries or infections, tissue cavities are formed on the one hand by dying tissue and on the other hand by the serum fluid known as exudate. During these processes, the hair vessels (smallest blood capillaries) become permeable to macromolecules and cells so that defense cells and hormones can reach the site of inflammation. This is how the body tries to get rid of dead body cells and pathogens. Both abscesses and seromas can form in the process. Seromas usually form on the surface of the skin and are manifested by painless swellings. They often manifest after surgery on closed skin wounds. The formation of seromas is often caused by irritation triggered by foreign bodies or by impeded lymphatic drainage in the wound area. They usually develop in large wounds and in disorders of protein metabolism.
Diseases with this symptom
- Wound healing disorders
- Empyema
Diagnosis and course
Seromas are characterized by skin swellings that are not discolored 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 impeded by a seroma. Even in the absence of infectious processes, wound healing is impaired. However, a seroma can also become inflamed if it persists for a long time and serve as a starting point for further infections. Smaller seromas, however, usually heal on their own. Larger seromas should be punctured. In order to be able to treat seromas properly, however, they must first be diagnosed beyond doubt. Differentially, the seroma must be distinguished from a hematoma and an abscess. Two main procedures are used for diagnosis. These are palpation on the one hand and sonography on the other. Palpation is the manual examination of the patient. The body structures are palpated with one or more fingers or the hands. In particular, palpation involves examining the parameters of size, elasticity, firmness, mobility and pain sensitivity of the examined body region. Palpation already provides valuable information about the type of swelling. For example, if the swelling remains colorless and insensitive to pressure, there is an urgent suspicion of a seroma. The diagnosis can further be confirmed by sonography.
Complications
In most cases, a seroma heals on its own and does not lead to further symptoms and complications. This is especially the case if the seroma is small and does not cause much pain.However, if the seroma is large and hurts, it should be treated by a doctor. Inflammation or infection may 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 also complain of reddened skin and itching. The affected person should not scratch the skin under any circumstances, as this only intensifies the itching. Inflammation at the seroma can spread to the neighboring skin areas and lead to swelling and sores there as well. 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. Because of the slowed wound healing due to the seroma, the patient may not be able to perform certain things because they are associated with pain. In rare cases, the patient is then dependent on the help of others. However, with timely treatment, a seroma can be removed and will not cause further discomfort.
When should you go to the doctor?
In most cases, small seromas heal on their own and do not result in any symptoms. If a large seroma is suspected, a doctor must be consulted. Anyone who notices inflammation at the wound after surgery, which may have already formed pus, should discuss this with the attending physician. If left untreated, a seroma can interfere with wound healing and cause pain. Signs of a seroma include redness around the wound and increasing itching. If other symptoms such as fever or sores develop, the seroma may have already spread to neighboring areas of skin. A visit to the doctor is then recommended to avoid a severe course and the formation of scars. Seromas in children, elderly people and patients with a skin disease must be treated medically in any case. 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 interfere with the healing of the original wound.
Treatment and therapy
Treatment of seromas is individualized and based on their size and potential to interfere with wound healing. Smaller seromas usually heal on their own. Larger swellings may require sterile puncture of the contents. This involves placing a cannula at the swollen site and aspirating the exudate. A prerequisite for punctures to be performed correctly is sterile work in order to avoid infections. To this end, care must be taken to ensure adequate skin disinfection at the puncture site. If the seroma is extremely large and even painful, a so-called redon drainage should be performed as a prophylaxis. The same applies to the occurrence of frequent recurrences. Redon drainage is a suction drainage system for draining wound secretions. The secretion is drained outward in a closed system with a controlled suction. A thin plastic tube, perforated several times at the end, is attached to the body via a suture to prevent it from slipping out. The exudate is sucked out by a continuously prevailing negative pressure and collected in a plastic bottle at the other end of the tube. The bottle is changed regularly to renew the negative pressure. During drainage, it is imperative that the wound cavity is sealed airtight to the outside. A redon usually lasts 48 to 72 hours. Most often, redon drainage is necessary postoperatively after extensive surgery.
Outlook and prognosis
There is usually no pain or discomfort from pressure with a seroma. However, the appearance of the seroma greatly delays the healing of a wound. This can cause inflammation and infection at the wound itself, which eventually leads 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 be consulted if the seroma has become relatively large and is associated with pain. In this case, the affected area usually develops a rash on the skin, redness and severe itching. The affected person should avoid scratching the skin, as this will only aggravate the seroma.If the seroma is not treated properly, it can spread to an adjacent area on the skin and cause unpleasant symptoms there as well. The treatment at the doctor’s office is performed with a surgery and does not cause any further discomfort. Especially after surgery, a seroma should be treated by a doctor so that there are no further symptoms in the affected area.
Prevention
A specific prevention from a seroma is not possible. Only after extensive surgery following an injury or illness is redon drainage recommended as a prophylactic measure to drain the wound secretions as quickly as possible. The use of this drainage is also recommended for recurrent seromas. This can effectively prevent wound healing problems.
What you can do yourself
A seroma is generally not considered a hindrance in everyday life. However, an extensive seroma can lead to poor physical well-being. Particularly affected areas in the head area often have a deterrent effect visually and then also cause psychological suffering in the affected person. The desire to treat it oneself is therefore very understandable. However, there is no scientifically proven effective method for self-treatment. A wound dressing can be applied, which must then be changed regularly. The wound should be cleaned with a disinfectant that can be purchased at a pharmacy. What should be avoided at all costs is scratching the affected areas. This could lead to further spread and aggravation of the condition. A small seroma usually heals on its own. If the seroma has developed over a large area, a doctor should be consulted in any case. A doctor should also be consulted if the affected area of skin is painful or itchy. Even if there is no pain or itching, but the psychological suffering gets out of hand, doctors are usually helpful. Medical treatment options are straightforward and effective.
