Date: Wed, 29 Dec 2004 18:36:23 -0500
Subject: Flank Seroma
From: Charles M. Blitzer
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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
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.
TD
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.
Chip
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
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,
Regards
Chris Wilson
co-chief ortho trauma
loyola
University Hospital Cardiff UK