How do I treat 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 a serous fluid collection under the skin flaps following surgery, commonly occurring after procedures that create anatomical dead space 1
• Seromas must be distinguished from surgical site infections, which present with purulent drainage, pain, tenderness, redness, induration, and systemic signs of infection 1

Primary Treatment Approach

• For small seromas:

  • Drain the fluid collection by needle aspiration under sterile conditions 1
  • Apply a clean, dry dressing to the incision site 1
  • Monitor for recurrence or signs of infection 1

• For recurrent or large seromas:

  • Open part of the incision to allow complete drainage 1
  • Perform dressing changes until the wound heals by secondary intention 1
  • Consider more frequent follow-up to ensure proper healing 1

Advanced Management Options

• For persistent or chronic seromas:

  • Negative pressure wound therapy (NPWT) is highly effective for managing chronic seromas by:
    • Promoting granulation tissue formation 1
    • Obliterating dead space 1, 2
    • Significantly reducing surgical site infections compared to standard dressings (pooled OR, 0.25; 95% CI, 0.12–0.52) 1, 3
  • The procedure involves surgical drainage of the seroma, capsulectomy, and application of NPWT until adequate granulation tissue forms 2

• For extremely persistent seromas (rare in cesarean incisions):

  • Sclerotherapy or talcum powder sprinkling in the seroma cavity has been reported as effective in case reports for persistent seromas not responding to other treatments 4

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 1

Prevention Strategies for Future Cesarean Deliveries

• Subcutaneous tissue approximation in women with ≥2 cm of subcutaneous fat significantly reduces seroma formation (5.1% vs 17.2%, RR 0.3,95% CI 0.1-0.7) 5, 6
• Use subcuticular suture for skin closure rather than staples to reduce wound complications 1, 6
• Consider subcutaneous saline irrigation before closure, which has been shown to decrease postoperative seroma formation 7
• For high-risk patients (obesity, diabetes, immunosuppression), consider prophylactic NPWT, which reduces surgical site infection risk (pooled RR, 0.45; 95% CI, 0.31-0.66) 3

Follow-up Care

• Monitor the wound until complete healing occurs 1
• Educate the patient about signs of infection requiring immediate medical attention:
  • Increasing pain, redness, or swelling 1
  • Purulent drainage 1
  • Fever or chills 1
• For patients with recurrent seromas, more frequent follow-up may be necessary to ensure proper healing 1