How To Prevent Seroma After Tummy Tuck
Can J Plast Surg. 2009 Winter; 17(four): 127–129.
Linguistic communication: English language | French
Postoperative seroma formation afterwards abdominoplasty with placement of continuous infusion local coldhearted pain pump
Melissa M Smith, Doc, Michael P Lin, Md MS, Raffi V Hovsepian, MD MS, David Wood, MD FACS, Trung Nguyen, MD, Gregory RD Evans, MD FACS, and Garrett A Wirth, MD FACS
Abstruse
The most common complication after abdominoplasty is seroma germination. The incidence of seroma germination in abdominal procedures as a whole, including abdominoplasty, panniculectomy and transverse rectus abdominis myocutaneous flap abdominal donor sites, ranges from 1% to 38%. A recent concern among surgeons is the possibility of a causal relationship between the apply of continuous infusion devices such as local coldhearted pain pumps and the development of seromas. A case of postoperative, persistent, recurrent seroma germination after abdominoplasty with the use of continuous infusion local coldhearted pain pump is presented. After several attempts at aspiration and bleed catheter placement, only open up surgical excision of the seroma cavity was found to be definitively effective in treating the development of seroma.
Keywords: Abdominoplasty, Local anesthetic, Hurting pump, Seroma
Résumé
La complication la plus fréquente après une abdominoplastie est la formation de séromes. Dans l'ensemble, l'incidence des séromes lors d'interventions abdominales varie de one à 38 %, y compris lors de fifty'abdominoplastie, de la panniculectomie et dans les sites abdominaux donneurs de lambeaux myocutanés du transverse de l'abdomen. Les chirurgiens se sont récemment inquiétés de la possibilité d'united nations lien causal entre l'emploi d'appareils cascade perfusion continue, comme les pompes anesthésiques locales, et la formation de séromes. On présente ici un cas de sérome post-opératoire persistant et récurrent après une abdominoplastie avec emploi d'une pompe anesthésique locale pour perfusion continue. Après plusieurs tentatives d'aspiration et la pose d'un drain, seule une excision chirurgicale ouverte du sérome a permis de traiter définitivement ce cas.
Abdominoplasty has become a widely popular procedure, with the number of abdominoplasty procedures increasing 55% from 2000 until 2006 (one,2). The well-nigh mutual complication after abdominoplasty is seroma formation (ane,iii). The incidence of seroma formation in intestinal procedures as a whole, including abdominoplasty, panniculectomy and transverse rectus abdominis myocutaneous flap abdominal donor sites, ranges from ane% to 38% (ane,iv–20). This incidence appears to increase with patient obesity, wide undermining, extensive utilize of cautery autopsy, use of sharp liposuction cannulas, and the weight of skin excised (1,8,13,20–26). A recent concern amongst surgeons is the possibility of a causal relationship between the use of continuous infusion devices such as local coldhearted pain pumps and the development of seromas.
We report a case of postoperative, persistent, recurrent seroma formation later abdominoplasty with the use of continuous infusion local anesthetic pain pump.
CASE PRESENTATION
A 61-year-old African-American woman presented with complaints of abdominal laxity and excess abdominal skin. She had three pregnancies in the by and had recently achieved and maintained a xiii.5 kg weight loss through nutrition and exercise. She had remained stable at her current weight for over i year preoperatively. Her pertinent medical history included iron deficiency anemia, hypertension, obesity, peptic ulcer illness, hypothyroidism, diabetes and hyperlipidemia. She denied any apply of booze, tobacco or illicit substances.
The patient underwent an abdominoplasty with vertical and oblique plication of the rectus abdominis fascia. Dissection was carried out at the level of the abdominal fascia just nether Scarpa'south fascia. Catheters to a continuous infusion local anesthetic pain pump arrangement (On-Q, I-Menses Corporation, The states), as well as two Jackson-Pratt drains were placed straight on the surface of the rectus abdominis fascia. The pain pump reservoir was filled with the recommended 400 mL of 0.25% bupivacaine, allowing a continuous infusion of 4 mL/h (two mL/h/catheter × 2 catheters) of local anesthetic to aid in postoperative pain command.
The patient was kept overnight for observation, and afterward discharged the post-obit day without incident. On postoperative day five, the hurting pump reservoir was empty and the catheters were removed. The Jackson-Pratt drains were discontinued on postoperative days ix and fourteen, at which point each drain's cumulative output was less than 30 mL per 24 h menstruum, for a minimum of three consecutive days.
During the first postoperative month the patient developed a suspected seroma supraumbilically, but no fluid could be evacuated. Despite multiple failed aspiration attempts on multiple function visits, the fluid collection persisted. Two months after her initial operation the patient underwent operative placement of a drain under local anesthesia and sedation. Intraoperatively, 100 mL of fluid was removed, and a Jackson-Pratt bleed was placed. The drain was removed postoperatively once the above-mentioned removal parameters were met on postoperative twenty-four hour period x. An intestinal compression garment was applied for two months.
The patient re-presented with recurrent upper intestinal fullness six months postoperatively (Figure 1). Computed tomography scan revealed a large fluid collection (Figure 2). During the seventh and eighth months after the initial procedure, fluid was aspirated from the seroma cavity on 4 separate clinic visits. Bacterial and fungal cultures were obtained but were negative for growth. Ultrasound evaluation demonstrated a multiloculated cystic structure in the upper intestinal mid-line (Effigy 3).
Patient half-dozen months subsequently abdominoplasty with upper intestinal fullness noted on anterior view (left) and lateral view (right), despite multiple drainage procedures
Computed tomography scan revealing an ovoid upper abdominal fluid drove measuring 8.two cm × two.7 cm × 5.5 cm with a well-defined wall
Ultrasound revealing a multiloculated cystic structure in the midline upper belly measuring 7.one cm × 3.four cm × ane.0 cm
Eleven months after her initial procedure, open up drainage and resection of a ten cm × vi cm seroma cavity was performed (Figure four), along with Jackson-Pratt bleed placement. There has been no fluid collection recurrence to appointment, indicating that surgical excision of the seroma cavity was the disquisitional step in successful treatment of this patient's persistent, recurrent, postoperative seroma (Figure 5).
Surgical excision of the midline upper abdominal multiloculated seroma cavity. Views of intact seroma capsule (left), and multiloculated interior (correct)
Post-operative view subsequently open up excision of the midline upper intestinal seroma on inductive view (left) and lateral view (right)
Discussion
Seroma germination is the most common complication subsequently abdominoplasty (1,three,seven,viii,13). Its incidence following abdominoplasty ranges from 1% to 38% (7,8,thirteen). The incidence appears to increase with patient obesity, wide undermining, extensive use of cautery autopsy, employ of sharp liposuction cannulas and the weight of skin excised (1,8,13,20–26). Pathophysiology for seroma formation is thought to be related to the disruption of lymphatic and vascular channels (27). The placement of drainage catheters has been used to prevent germination of seroma. Other techniques used to foreclose seromas afterwards abdominoplasty include quilting sutures, progressive tension closures, and preserving layer of fascia immediately anterior to rectus sheath and external oblique fascia (ie, innominate fascia of Gallaudet) (28–33). The use of quilting sutures and progressive tension sutures are both found to be effective, but with efficacy similar to catheter drainage alone (28–xxx). The efficacy of preservation of fascia immediately anterior to the rectus sheath and external oblique fascia (ie, innominate fascia of Gallaudet) to prevent seroma formation (31–33) is non well studied. A continuous infusion local anesthetic pain pump was used in this patient, which would support the possibility of a correlation between the utilise of continuous infusion pain pumps and the development of seroma. Still, little data currently exist to confirm this correlation (1).
Options for treating seromas include needle aspiration, sclerotherapy, placement of a seroma catheter and excision of the seroma crenel. Few studies have demonstrated the effectiveness of each approach in treating seromas in post-abdominoplasty patients. Shermak et al (26) propose including each of these techniques equally office of an algorithmic arroyo to treat seromas after body contouring surgery.
CONCLUSIONS
Seroma formation is a common complication occurring after abdominoplasty, often requiring multiple interventions to gear up the problem. In our case study, seroma formation occurred later on abdominoplasty with use of continuous infusion local anesthetic pain pump. Later on several attempts at aspiration and drain catheter placement, only open up surgical excision of the seroma cavity was establish to exist definitively effective in treating the development of seroma.
Footnotes
SOURCES OF FUNDING SUPPORTING THIS WORK: None.
DISCLOSURE OF Fiscal INTEREST AND COMMERCIAL ASSOCIATIONS: None.
REFERENCES
i. Smith MM, Hovsepian RV, Markarian MK, et al. Continuous-infusion local coldhearted pain pump use and seroma formation with abdominal procedures: is at that place a correlation? Plast Reconstr Surg. 2008;122:1425–xxx. [PubMed] [Google Scholar]
2. American Society of Plastic and Reconstructive Surgeons 2000/2005/2006 National Plastic Surgery Statistics: Cosmetic and Reconstructive Procedure Trends. < world wide web.plasticsurgery.org>
3. Teimourian B. Management of seroma in abdominoplasty. Aesthet Surg J. 2005;25:510–1. [PubMed] [Google Scholar]
4. Teimourian B, Roger WB. A national survey of complications associated with suction lipectomy; a comparative written report. Plast Reconstr Surg. 1989;84:628. [PubMed] [Google Scholar]
5. Pitman GH, Teimourian B. Suction lipectomy complications and results past survey. Plast Reconstr Surg. 1985;76:66. [PubMed] [Google Scholar]
half-dozen. Hensel JM, Lehman JA, Tantri PM, et al. An outcomes assay and satisfaction survey of 199 sequent abdominoplasties. Ann Plast Surg. 2001;46:357. [PubMed] [Google Scholar]
7. Hafezi F, Nouhi AH.Abdominoplasty and seroma Ann Plast Surg 200248109(Lett) [PubMed] [Google Scholar]
8. Dillerud Eastward. Abdominoplasty combined with suction lipoplasty: A study of complications, revisions, and run a risk factors in 487 cases. Ann Plast Surg. 1990;25:333. [PubMed] [Google Scholar]
9. Grazer FM, Goldwyn RM. Abdominoplasty assessed by surgery. Plast Reconstr Surg. 1977;59:513. [PubMed] [Google Scholar]
10. Pitanguy I. Body profile. Am J Cosmet Surg. 1987;iv:283. [Google Scholar]
xi. Vanderbussche PA, Debaere PA, Vandervord J, et al. Lipectomies abdominales et necroses. Ann Chir Plast. 1978;23:162. [PubMed] [Google Scholar]
12. Van Uchelen JH, Werker PM, Kon M. Complications of abdominoplasty in 86 patients. Plast Reconstr Surg. 2001;107:1869. [PubMed] [Google Scholar]
13. Kim J, Stevenson TR. Abdominoplasty, liposuction of the flanks, and obesity: Analyzing take chances factors for seroma germination. Plast Reconstr Surg. 2006;117:773. [PubMed] [Google Scholar]
14. Regnault P. Abdominal demolipectomies. Clin Plast Surg. 1975;2:411. [PubMed] [Google Scholar]
15. Pitanguy I. Abdominolipectomy: An approach to it through an assay of 300 consecutive cases. Plast Reconstr Surg. 1967;40:384. [Google Scholar]
16. Pitanguy I. Evaluation of body contouring surgery today: A 30 year perspective. Plast Reconstr Surg. 2000;105:1499. [PubMed] [Google Scholar]
17. Pitanguy I. Evaluation of body contouring surgery today: A 30 yr perspective: Give-and-take. Plast Reconstr Surg. 2000;105:1515. [PubMed] [Google Scholar]
18. Stevens WG, Spring MA, Stoker DA, et al. X years of outpatient abdominoplasties: Safe and effective. Aesthetic Surg J. 2007;27:269. [PubMed] [Google Scholar]
19. Scevola Southward, Youssef A, Kroll SS, et al. Drains and seromas in TRAM flap breast reconstruction. Ann Plast Surg. 2002;48:511. [PubMed] [Google Scholar]
20. Chang DW, Wang BG, Robb GL, et al. Effect of obesity on flap and donor-site complications in free transverse rectus abdominis myocutaneous flap breast reconstruction. Plast Reconstr Surg. 2000;105:640. [PubMed] [Google Scholar]
21. Aguolu K. Long standing setoma Later ultrasound assisted liposuction. Ann Plast Surg. 2001;46:573. [PubMed] [Google Scholar]
22. Pitman GH. Liposuction and Aesthetic Surgery. St Louis: Quality Medical Publishing; 1993. [Google Scholar]
23. Matarasso A. Liposuction as an adjuvant to a full abdominoplasty. Plast Reconstr Surg. 1995;95:829. [PubMed] [Google Scholar]
24. Vastine VL, Morgan RF, Williams GS, et al. Wound complications of abdominoplasty in obese patients. Ann Plast Surg. 1999;42:34. [PubMed] [Google Scholar]
25. Mulbauer Westward. Radical abdominoplasty, including body-shaping: Representative cases. Aesth Plast Surg. 1989;xiii:105. [PubMed] [Google Scholar]
26. Shermak MA, Rotellini-Coltvet LA, Chang D. Seroma evolution following body contouring surgery for massive weight loss: Patient take a chance factors and treatment strategies. Plast Reconstr Surg. 2008;122:280–8. [PubMed] [Google Scholar]
27. Andrades P, Prado A. Limerick of Postabdominoplasty Seroma. Aesthetic Plast Surg. 2007;31:514–8. [PubMed] [Google Scholar]
28. Nahas FX, Ferreira LM, Ghelfond C. Does quilting suture prevent seroma in abdominoplasty? Plast Reconstr Surg. 2007;119:1060–4. 1065–6. [PubMed] [Google Scholar]
29. Pollock T, Pollock H. Progressive tension sutures in abdominoplasty. Clin Plast Surg. 2004;31:583–nine. [PubMed] [Google Scholar]
xxx. Andrades P, Prado A, Danilla Southward, et al. Progressive tension sutures in the prevention of postabdominoplasty seroma: A prospective, randomized, double-blind clinical trial. Plast Reconstr Surg. 2007;120:935–46. 947–51. [PubMed] [Google Scholar]
31. Flament JB, Avisse C, Delattre JF. Abdominal Wall Hernias. New York: Springer Verlag; 2001. Beefcake of the Abdominal Wall. [Google Scholar]
32. Skandalakis JE, Skandalakis PN, Skandalakis LJ, et al. Surgical Anatomy and Technique: A Pocket Transmission. second edn. New York: Springer Verlag; 1999. Intestinal Wall and Hernias. [Google Scholar]
33. Lee D, Noronha V. Concepts in classical abdominoplasty: Radical surgery is more than and better. The Hong Kong Medical Library. 2008;xiii:iv–7. [Google Scholar]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827279/
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