Any surgical intervention is a great test for the patient's body. This is due to the fact that all its organs and systems are experiencing increased stress, it does not matter whether the operation is small or large. The skin, blood and lymph vessels are especially “given” , and if the operation is performed under anesthesia, then the heart. Sometimes, after everything seems to be behind, a person is diagnosed with “postoperative suture seroma”. What is it, most patients do not know, so many are afraid of unfamiliar terms. In fact, seroma is not as dangerous as, for example, sepsis, although it also does not bring anything good with itself. Consider how it turns out, what is dangerous and how it should be treated.
What is it - postoperative suture seroma
We all know that many surgeons in the operating room do “miracles” by literally returning a person from the other world. But, unfortunately, not all doctors conscientiously perform their actions during the operation. There are times when they forget cotton swabs in the patient’s body and do not fully ensure sterility. As a result, in the operated person, the suture becomes inflamed, begins to fester or diverge.
However, there are situations when problems with a suture have nothing to do with the negligence of doctors. That is, even if, during the operation, one hundred percent sterility is observed, a liquid suddenly accumulates in the patient’s area in the incision area, outwardly resembling a sacrum, or pus of a not very thick consistency. In such cases, they speak of postoperative suture seroma. What is it, in a nutshell, we can say this: this is the formation in the subcutaneous tissue of a cavity in which serous effusion accumulates. Its consistency can vary from liquid to viscous, the color is usually yellow-straw, sometimes supplemented with blood streaks.
Risk groups
Theoretically, seroma can occur after any violation of the integrity of the lymphatic vessels, which do not "know how" to thrombose quickly, as the blood vessels do. While they heal, a lymph moves over them for some time, flowing from the places of ruptures into the formed cavity. According to the classification system ICD 10, seroma of the postoperative suture does not have a separate code. It is affixed depending on the type of operation performed and on the reason that influenced the development of this complication. In practice, it most often happens after such cardinal surgical interventions:
- abdominal plastic;
- cesarean section (for this seroma of the postoperative suture, the ICD code is 10 "About 86.0", which means suppuration of the wound of the postoperative and / or infiltrate in its area);
- mastectomy.
As you can see, at risk are mainly women, and those of them who have solid subcutaneous fatty deposits. Why is that? Because these deposits, when damaged by their integral structure, tend to exfoliate from the muscle layer. As a result, subcutaneous cavities are formed in which fluid begins to collect from the lymph vessels broken during the operation.
Also at risk are such patients:
- suffering from diabetes;
- people of age (especially overweight);
- hypertension.
Causes
To better understand what it is - postoperative suture seroma, you need to know why it is formed. The main reasons do not depend on the competence of the surgeon, but are a consequence of the reaction of the body to surgical intervention. These reasons are:
- Body fat. This has already been mentioned, but we add that in too obese people, whose fat deposits are 50 mm or more, seroma appears in almost 100% of cases. Therefore, doctors, if the patient has time, recommend liposuction before the main operation.
- A large area of the wound surface. In such cases, too many lymph vessels are damaged, which, accordingly, secrete a lot of fluid, and heal longer.
Increased tissue trauma
It was mentioned above that the seroma of the postoperative suture depends on the conscientiousness of the surgeon a little. But this complication directly depends on the skills of the surgeon and on the quality of his surgical instruments. The reason seroma can occur is very simple: the tissue work was too traumatic.
What does it mean? An experienced surgeon, when performing an operation, works delicately with damaged tissues, does not squeeze them unnecessarily with forceps or clamps, is not enough, does not twist, the incision is performed quickly, in one exact movement. Of course, such jewelry work in many respects depends on the quality of the instrument. An inexperienced surgeon can create the so-called vinaigrette effect on the wound surface, which unnecessarily injures the tissue. In such cases, the postoperative suture seroma ICD 10 code can be assigned as follows: "T 80". This means "complication of surgical intervention, not noted in other sections of the classification system."
Excessive electrocoagulation
This is another reason that causes seam gray after surgery and to some extent depends on the competence of the doctor. What is coagulation in medical practice? This surgical intervention is not a classic scalpel, but a special coagulator that produces high-frequency electric current. In fact, this is a cauterization of vessels and / or cells by current. Coagulation is most often used in cosmetology. In surgery, she also proved herself to be excellent. But if a physician does it without experience, he may incorrectly calculate the required magnitude of the current strength or cauterize them with excess tissue. In this case, they undergo necrosis, and neighboring tissues become inflamed with the formation of exudate. In these cases, postoperative suture seroma in ICD 10 is also assigned the code “T 80”, but in practice such complications are very rarely recorded.
Clinical manifestations of small suture seroma
If the surgery was on a small area of the skin and the seam turned out to be small (accordingly, the doctor’s traumatic manipulations affected a small volume of tissue), seroma, as a rule, does not manifest itself. In medical practice, there are cases when patients did not even suspect about it, but such a formation was revealed during instrumental studies. Only in isolated cases does a small seroma cause minor pain.
How to treat it and is it necessary to do it? The decision is made by the attending physician. If he sees fit, he can prescribe anti-inflammatory and pain medication. Also, for a faster wound healing, the doctor can prescribe a number of physiotherapeutic procedures.
Clinical manifestations of large suture seroma
If the surgical intervention has affected a large volume of the patient’s tissue or the suture has turned out to be too large (the wound surface is extensive), the occurrence of seroma in patients is accompanied by a number of unpleasant sensations:
- redness of the skin in the seam area;
- drawing pains, aggravated in a standing position;
- during operations in the abdominal region of pain in the lower abdomen;
- swelling, bulging parts of the abdomen;
- temperature rise.
In addition, suppuration of both large and small seroma of the postoperative suture can occur. Treatment in such cases is very serious, up to surgery.
Diagnostics
We have already figured out why the seroma of the postoperative suture can occur and what it is. The methods for treating seroma, which we will discuss below, largely depend on the stage of its development. In order not to start the process, this complication must be discovered in time, which is especially important if it does not declare itself in any way. Diagnosis is carried out by the following methods:
Inspection by your doctor. After surgery, the doctor is required to examine the wound of his patient daily. If undesirable skin reactions (redness, swelling, suppuration of the suture) are detected, palpation is performed. If there is seroma, the doctor should feel a fluctuation under the fingers (flow of a liquid substrate).
Ultrasound This analysis perfectly shows whether or not there is accumulation of fluid in the seam area.
In rare cases, a puncture is taken from seroma in order to clarify the qualitative composition of the exudate and decide on further actions.
Conservative treatment
This type of therapy is most often practiced. In this case, patients are prescribed:
- antibiotics (to prevent possible further suppuration);
- anti-inflammatory drugs (they relieve inflammation of the skin around the seam and reduce the amount of fluid secreted into the subcutaneous cavity).
More often nonsteroidal drugs are prescribed, such as Naproxen, Ketoprofen, Meloxicam.
In some cases, the doctor may prescribe steroidal anti-inflammatory drugs, such as Kenalog, Diprospan, which block inflammation as much as possible and accelerate healing.
Surgery
According to indications, including the size of the seroma and the nature of its manifestation, surgical treatment can be prescribed. It includes:
1. Puncture. In this case, the doctor removes the contents of the resulting cavity with a syringe. The positive aspects of such manipulations are as follows:
- can be performed on an outpatient basis;
- painless procedure.
The disadvantage is that you will have to do a puncture more than once, and not even two, but up to 7 times. In some cases, up to 15 punctures have to be performed before the tissue structure is restored.
2. Installation of drainage. This method is used for too large seromas. When staging drainage, antibiotics are prescribed to patients in parallel.
Folk remedies
It is important to know that no matter what the reasons for postoperative suture seroma, folk remedies for this complication are not carried out.
But at home, you can perform a number of actions that contribute to the healing of the suture and are the prevention of suppuration. These include:
- lubrication of the seam with antiseptic alcohol-free agents (Fucorcin, Betadine);
- ointment application (Levosin, Vulnuzan, Kontraktubeks and others);
- inclusion of vitamins in the diet.
If suppuration has appeared in the suture area, it is necessary to treat it with antiseptic and alcohol-containing agents, for example, iodine. In addition, in these cases, antibiotics and anti-inflammatory drugs are prescribed.
Traditional medicine, with the aim of speedy healing of sutures, recommends making compresses with alcohol tincture of the stomach bone. For its preparation, only the roots of this herb are suitable. They are well washed from the ground, minced in a meat grinder, put in a jar and poured with vodka. Tincture is ready for use after 15 days. For the compress, you need to dilute it with water 1: 1, so that the skin does not get a burn.
There are many folk remedies for healing wounds and scars after surgery. Among them, sea buckthorn oil, rosehip oil, mummy, beeswax, melted with olive oil. These funds must be applied to gauze and applied to a scar or suture.
Postoperative seroma after cesarean
Complications in women whose obstetrics was performed by Caesarean section are common. One of the reasons for this phenomenon is the parturient body weakened by pregnancy, which is not able to provide rapid regeneration of damaged tissues. In addition to seroma, a ligature fistula or keloid scar may occur, and in the worst case, suppuration of the suture or sepsis. After caesarean section, seroma in women in labor is characterized by the fact that a small dense ball with exudate (lymph) inside appears on the suture. The reason for this is damaged vessels at the incision site. As a rule, it does not cause concern. Seroma of the postoperative suture after cesarean treatment does not require.
The only thing a woman can do at home is to treat the scar with rosehip oil or sea buckthorn oil for his healing as soon as possible.
Complications
Postoperative suture seroma does not always and not all pass by itself. In many cases, without a course of therapy, she is able to fester. Chronic diseases (for example, tonsillitis or sinusitis) can cause this complication, in which pathogenic microorganisms penetrate into the cavity formed after surgery through the lymph vessels. And the liquid that collects there is an ideal substrate for their reproduction.
Another unpleasant consequence of seroma, which was not paid attention to, is that subcutaneous fatty tissue does not merge with muscle tissues, that is, the cavity is constantly present. This leads to abnormal mobility of the skin, to tissue deformation. In such cases, repeated surgery is necessary.
Prevention
On the part of the medical staff, preventive measures consist in strict observance of the surgical rules for the operation. Doctors try to spontaneously perform electrocoagulation, less injure tissue.
On the part of patients, preventive measures should be as follows:
- Do not agree to surgery (if there is no urgent need for this) until the thickness of subcutaneous fat reaches 50 mm or more. This means that first you need to do liposuction, and after 3 months to carry out the operation.
- After surgery, wear high-quality compression knitwear.
- Exclude physical activity for at least 3 weeks after the operation.