What are the treatment options for seroma?

Treatment Options for Seroma

The most effective treatment for seroma is percutaneous aspiration, which should be performed as the first-line intervention for most seromas, with additional therapies such as sclerotherapy or surgical intervention reserved for persistent or recurrent cases. 1

Initial Management

• Percutaneous aspiration: First-line treatment for most seromas

  • Collect 10-50 mL of fluid (minimum) for diagnostic purposes if infection is suspected 1
  • May need to be repeated if fluid reaccumulates

• Compression dressing: Should be applied after aspiration to prevent reaccumulation

  • Helps obliterate dead space and prevent fluid collection 2

Management of Persistent Seromas

For seromas that persist despite initial aspiration and compression:

Sclerotherapy Options

1. Talc sclerotherapy:

   • Sterilized talcum powder can be sprinkled into the seroma cavity after thorough drying with gauze 3
   • Has shown effectiveness in treating persistent inguinal seromas
   • Apply 4g of sterilized talc followed by compression dressing

2. Plaster of Paris (POP) cast:

   • Particularly effective for auricular seromas 4
   • Apply after aspiration, taking the contour of the affected area
   • Keep in place for approximately 3 days

Surgical Interventions

For chronic or recurrent seromas resistant to conservative management:

1. Minimally invasive approach 5:

   • Three-puncture technique
   • Evacuation of serous fluid and fibrinous debris
   • Argon beam scarification of seroma cavity lining
   • Introduction of talc slurry

2. Vacuum-assisted closure therapy 6:

   • Indicated for chronic seromas not responsive to conservative treatment
   • Procedure includes:
     • Surgical drainage of the seroma
     • Capsulectomy
     • Application of vacuum-assisted closure therapy
     • Primary wound closure with closed suction drain placement
     • Elastic compression bandaging

3. Intracavitary thrombolytic therapy:

   • For complex, multiseptated fluid collections refractory to drainage
   • Uses fibrinolytic agents such as tissue plasminogen activator 1
   • Has shown high rates of clinical success in retrospective studies

Special Considerations

• Seroma location matters:

  • Breast seromas are common after mastectomy and axillary surgery 2
  • Inguinal seromas often occur after hernia repair 3
  • Auricular seromas may require specialized approaches 4

• Risk factors for seroma formation:

  • Body mass index and body weight 2
  • Use of electrocautery for dissection
  • Extensive surgical dissection

• Pitfalls to avoid:

  • Delaying treatment of infected seromas, which can lead to abscess formation
  • Premature removal of drains after initial surgery (within 24 hours) increases seroma formation 2
  • Aggressive early shoulder movement after breast/axillary surgery increases seroma risk

Monitoring and Follow-up

• Monitor for signs of infection (redness, warmth, increased pain)
• Follow-up after intervention to ensure resolution
• For persistent cases, consider imaging (ultrasound) to evaluate for complex or loculated seromas that may require more aggressive intervention

Remember that while many seromas will resolve with conservative management, recurrence is common, and multiple treatment sessions may be required for complete resolution.