The seroma is a non-cystic cavity (pseudocyst) in the tissue filled with lymph fluid and serum. It occurs with injuries or inflammatory processes in the corresponding organs. These processes create tissue cavities that, unlike true cysts, are not lined with epithelium . In the case of a seroma, the pseudocysts are filled with an exudate that forms during inflammatory processes. This is lymph fluid with proteins , enzymes , glucose and other blood components.

If the exudate contains other cell components that are decomposed by bacteria, pus is produced . The accumulation of purulent exudate in the pseudocyst is called an abscess . When red blood cells accumulate, it is a hematoma . An unlimited spread of the pus causes the clinical picture of a phlegmon . If the exudate flows into other body cavities, it is referred to as an effusion. With a purulent exudate, an empyema develops under these conditions . In contrast to a hematoma, a seroma remains painless when pressed on.

Causes

Seromas are mostly found on the surface of the skin. They can always form when inflammatory processes take place in the corresponding tissue parts. Seromas sometimes also develop as a result of injuries and wounds . In the case of inflammation caused by injuries or infections, tissue cavities are formed by dying tissue on the one hand and the serum liquid known as exudate on the other.

During these processes, the capillaries (tiniest blood capillaries) become permeable to macromolecules and cells, so that defense cells and hormones can reach the site of inflammation. This is how the body tries to get rid of dead body cells and pathogens. Both abscesses and seromas can form. Seromas usually form on the skin’s surface and appear as painless swellings .

They often manifest themselves after an operation on closed skin wounds. The formation of seromas is often caused by irritation caused by foreign bodies or by impaired lymphatic drainage in the wound area. They usually occur with large wounds and disorders of protein metabolism.

Diseases with this symptom

• Wound healing disorders
• empyema

Diagnosis & History

Seromas are characterized by skin swellings that do not change color and are usually insensitive to pressure. The collected fluid appears clear to cloudy-serous (serum fluid). In addition, it is colorless to slightly yellowish. Seromas do not cause pain. This does not change even when pressure is applied to the swollen area. However, wound healing is hampered by a seroma.

Even without infectious processes, wound healing disorders occur . However, a seroma can become inflamed even if it has existed for a long time and serve as a starting point for further infections. However, smaller seromas usually heal on their own. Larger seromas should be aspirated.

In order to be able to treat seromas properly, however, they must first be diagnosed beyond doubt. In the differential diagnosis, the seroma must be distinguished from a hematoma and an abscess. Two main methods are used for diagnosis. This is palpation on the one hand and sonography on the other . Palpation is the manual examination of the patient.

The body structures are felt with one or more fingers or hands. In particular, palpation involves examining the parameters of size, elasticity, firmness, mobility and sensitivity to pain of the examined body region. Even palpation provides valuable information about the type of swelling. If the swelling remains colorless and is not sensitive to pressure, there is an urgent suspicion of a seroma. The diagnosis can also be confirmed by sonography.

Complications

In most cases, a seroma will heal on its own without causing further discomfort or complications. This is especially the case if the seroma is small and not particularly painful. However, if the seroma is large and painful, treatment should be carried out by a doctor. Inflammation or infection can develop on the seroma.

As a rule, they slow down the process of wound healing and often lead to pain. It is not uncommon for patients to complain of reddened skin and itching . The person concerned should not scratch the skin under any circumstances, as this will only increase the itching.

Inflammation at the seroma can spread to the neighboring areas of the skin and also lead to swelling and sores there. If the seroma is not treated in time, it often leaves a scar on the skin. Whether this scar will disappear again cannot be universally predicted.

Due to the slow healing of wounds due to the seroma, the patient may not be able to do certain things that are associated with pain. In rare cases, the patient is then dependent on the help of other people. With timely treatment, however, a seroma can be removed and does not lead to any further symptoms.

When should you go to the doctor?

In most cases, small seromas heal by themselves and do not result in any symptoms. If a large seroma is suspected, it is necessary to consult a doctor. Anyone who notices an inflammation of the wound after an operation, which may have already formed pus, should discuss this with the attending physician. Left untreated, a seroma can interfere with wound healing and cause pain. Signs of a seroma are redness in the area of ​​the wound and increasing itching.

If other symptoms such as fever or wounds develop, the seroma may have already spread to neighboring areas of skin. Then a doctor’s visit is recommended to avoid a severe course and the formation of scars. Seromas in children, the elderly and patients with a skin disease must always be treated medically. This is especially true if the inflammation develops into a chronic problem. Although serious subsequent symptoms are rare, if left untreated, a seroma can have a negative impact on general well-being and disrupt the healing of the original wound.

Treatment & Therapy

Treatment of seromas is individual, based on their size and potential to impede wound healing. Smaller seromas usually heal on their own. In the case of larger swellings, the contents may have to be drained off sterilely. A cannula is placed on the swollen area and the exudate is suctioned out. A prerequisite for a skillfully performed puncture is sterile work in order to avoid infections. Sufficient skin disinfection at the puncture site must be ensured.

If the seroma is extremely large and even painful, a so-called redon drainage should be carried out as a prophylaxis. The same applies to the occurrence of frequent recurrences. A Redon drainage is a suction drainage for draining off wound secretions. The secretion is guided to the outside in a closed system with a controlled suction. A thin plastic tube with multiple perforations at the end is attached to the body with a seam to prevent it from slipping out.

The exudate is sucked out by a continuously prevailing negative pressure and collected in a plastic bottle at the other end of the tube. The bottle is changed regularly to renew the negative pressure. During drainage, it is imperative that the wound cavity is sealed airtight to the outside. A Redon usually lasts 48 to 72 hours. Redon drainage is usually necessary postoperatively after extensive surgical intervention.

Outlook & Forecast

As a rule, there is no pain or discomfort with a seroma. However, the occurrence of the seroma greatly delays the healing of a wound. This can lead to inflammation and infection in the wound itself, which eventually leads to pain.

Usually no special treatment is necessary for a seroma and the seroma disappears on its own after a while. The doctor must be consulted when the seroma has become relatively large and is associated with pain. Here, the affected area usually develops a rash on the skin, reddening and severe itching. The sufferer should avoid scratching the skin as this will only intensify the seroma.

If the seroma is not treated properly, it can spread to an adjacent area on the skin and cause uncomfortable symptoms there as well. The treatment at the doctor’s is carried out with an intervention and does not cause any further complaints. Especially after an operation, a seroma should be treated by a doctor so that there are no further symptoms in the affected area.

Prevention

Targeted prevention of a seroma is not possible. Redon drainage is only recommended as a prophylactic measure after an extensive surgical intervention after an injury or illness in order to drain the wound secretion as quickly as possible. The use of this drainage is also recommended for recurring seromas. As a result, wound healing disorders can be effectively prevented.

You can do that yourself

A seroma is generally not perceived as a hindrance in everyday life. However, a large seroma can lead to poor physical condition. Affected areas in the head area in particular often have a visually deterrent effect and then also cause psychological distress in those affected. The desire to treat it yourself is therefore very understandable. However, there is no scientifically proven effective method for self-treatment.

A wound dressing can be applied, which must then be changed regularly. The wound must be cleaned with a disinfectant that can be bought in the pharmacy . What should be avoided at all costs is scratching the affected areas. This could lead to further spread and worsening of the condition. A small seroma usually heals on its own.

If the seroma is extensive, a doctor must be consulted in any case. A doctor should also be consulted if the affected area of ​​skin hurts or is very itchy. Even if there is no pain or itching , but the psychological suffering is getting out of hand, doctors are usually there to help. The medical treatment options are uncomplicated and effective.