Date: Wed, 29 Dec 2004 18:36:23 -0500

Subject: Flank Seroma

From: Charles M. Blitzer

CT is of 30 yo who crashed mtn bike 6 months ago. He continues to be bothered by mass in his lower flank.

I have heard of aspirating and injecting with a sclerosing agent (talc or tetracycline). I have been unable to find a useful discussion as to how this is done, likely success vs pontential complications.

Any thoughts regarding management would be appreciated. Should it just be surgically excised?

Thanks for your thoughts.

Charles Blitzer

Reply at: Orthopaedic Trauma Association forum

Date: Wed, 29 Dec 2004 18:58:54 EST

From: Tadabq

Have you tried simply aspirating it and applying a compressive dressing for a while? Perhaps, after 6 months, it would simply recur but it might help or even cure it.


From: Chip Routt

Subject: Re: Flank Seroma

There are a variety of techniques for managing these.

For symptomatic and chronic situations, you may like to consult your Plastic Surgery colleague for help.

Needle drainage, open drainage with wrapping, lesion excision, fascial fenestration after drainage, bolster closures after open drainage, and sclerosing injections are some common options used alone or in combinations.

The VAC device seems to have good early results anecdotally...drain it thru a non-dependant (anterior-superior) incision, apply the VAC, leave it for "a very long time" , take it off, graft or let the VAC site granulate.


M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
Seattle, WA 98104-2499

Date: Wed, 29 Dec 2004 22:24:54 -0500

From: edward harvey

One thing to add to Chip's extensive list- Liposuction technique

ed h

Date: Thu, 30 Dec 2004 10:20:59 -0600

From: Steven Rabin

Anecdotally, I have dealt with two similar massive thigh seromas after crush injury. Once it reaches the seroma stage, compressive dressings alone won't work. The two I treated had been previously treated with sclerosing agents, but my impression is that the sclerosing agents made the situation worse instead of better since they converted one large seroma into multiple small ones that were all scarred together and adherant. Eventually, both were eliminated by agressive debridement removing the entire seroma lesions including capsule,membrane-like granulomatous tissue and fibrousscar tissue etc.and in both i didnt' get it all the first time, but after a second evenmore aggressive debridement, did. Assume these are tumors and treat them as such. (In the first case, it was before we had wound VAC's and it took forever to heal. The second case, I used the VAC, and it healed much more rapidly, but still took 3 months)

Good luck

steve rabin
co-chief ortho trauma

Date: Thu, 30 Dec 2004 16:55:51 -0000

From: chris wilson

A well established chronic seroma like this is analagous to the "pseudo tumour" seen in haemophiliacs who bleed chronically into a muscle belly,of which I have some experience. Once a capsule has formed( MRI or U/S scan will help you there) simple drainage and compression will not help in the long term ,and you should plan to remove it with its capsule and then use mild compression dressings for several months,


Chris Wilson
University Hospital Cardiff UK