What is the treatment for a cesarean section (C-section) incision with a seroma?

Treatment of Cesarean Section Incision Seroma

The primary treatment for a cesarean section incision seroma is prompt drainage of the fluid collection, followed by appropriate wound care to allow healing by secondary intention. 1

Diagnosis and Assessment

• A seroma is defined as a serous fluid collection under the skin flaps following surgery, which commonly occurs after procedures that create anatomical dead space 2
• Seromas after cesarean section typically present as a fluctuant swelling at the incision site without significant erythema or systemic signs of infection 1
• Distinguish seroma from surgical site infection (SSI), which would present with purulent drainage, pain, tenderness, redness, and induration 1

Primary Treatment Approach

• Drainage is the cornerstone of seroma management:

  • Perform transcutaneous aspiration of the seroma using sterile technique 2
  • For recurrent or large seromas, consider opening part of the incision to allow complete drainage 1
  • Continue dressing changes until the wound heals by secondary intention 1

• After drainage, apply gentle compression dressing to help prevent reaccumulation 3

  • While compression dressings alone don't significantly reduce seroma formation, they can reduce drainage duration 3

Management of Recurrent Seromas

• For persistent or recurrent seromas not responding to simple aspiration:
  • Consider surgical intervention with capsulectomy (removal of the pseudocapsule that forms around chronic seromas) 4
  • Negative pressure wound therapy (NPWT) may be beneficial for chronic seromas by promoting granulation tissue formation and obliterating dead space 4
  • NPWT has shown significant reduction in surgical site infections compared to standard dressings (pooled OR, 0.25; 95% CI, 0.12–0.52) 5

Antibiotic Use

• Antibiotics are NOT routinely indicated for uncomplicated seromas without signs of infection 1
• Add antibiotics only if there are signs of infection with systemic involvement:
  • Temperature >38.5°C or heart rate >110 beats/minute 1
  • Erythema extending >5 cm from the wound edge 1
  • Presence of purulent drainage or other signs of infection 1

Prevention Strategies for Future Cesarean Deliveries

• For patients with history of seroma formation, consider these preventive measures in future cesarean deliveries:
  • Reapproximation of subcutaneous tissue when thickness is ≥2 cm significantly reduces seroma formation (5.1% vs 17.2%, RR 0.3,95% CI 0.1-0.7) 6
  • Consider subcutaneous saline irrigation before closure, which has been shown to decrease postoperative seroma formation 7
  • Use subcuticular suture for skin closure rather than staples to reduce wound complications 5
  • Consider negative pressure wound therapy for high-risk patients 5

Follow-up Care

• Monitor the wound until complete healing occurs 1
• If seroma recurs after initial drainage, repeated aspiration may be necessary 2
• For chronic seromas not responding to conservative management, surgical intervention with NPWT may be required 4

Common Pitfalls and Considerations

• Avoid early aggressive shoulder movement in the immediate postoperative period as it may increase seroma formation 2
• Body mass index (BMI) and body weight are patient factors that affect seroma formation; higher BMI increases risk 2, 3
• Very early drain removal (within 24 hours) may increase seroma formation, while removal around day 7 appears safe regardless of output volume 3