How to deal with a seroma

Re: How to deal with a seroma

Henry L'Eplattenier — Wed, 30 Apr 2014 18:00:13 GMT

[quote user="Anthony Todd"]

Jeepers, if you pressure bandage them they're always gone in a week, and remember this is a dependent area so fluid goes to the lowest point. I can't believe how much advice has been given and faffing about for such a simple thing with an obvious solution.

[/quote]

Pressure bandaging is of course an option, but as others have pointed out the location may be difficult to bandage effectively. I typically see seromas in the axilla/ventral chest after thoracotomy or after limb amputation (front or hind), and as these are often large dogs, bandaging is both impractical and expensive.

Warning the owners about the time it may take for the seroma to heal is I guess just my way of keeping the owners' expectations low and telling them to be patient in order to prevent them from worrying and calling every couple of days.

Re: How to deal with a seroma

Anthony Dennison — Wed, 30 Apr 2014 17:53:06 GMT

In most situations that is the best option Anthony, I agree, but as mentioned it's not an easy site to bandage with this example!

Re: How to deal with a seroma

Anthony Todd — Wed, 30 Apr 2014 17:40:19 GMT

[quote user="Henry L'Eplattenier"] I always tell them though that it is likely to get worse before it starts getting better, and that it will take several weeks to disappear completely. But as long as the swelling stays soft and painless, I tell them there is nothing to worry about.[/quote]

Re: How to deal with a seroma

Henry L'Eplattenier — Wed, 30 Apr 2014 17:27:56 GMT

If the diagnosis of seroma is confirmed, I usually tell the owners to use hot packs or a hot water bottle on the area 3-4 times a day for about 5 minutes. This is advice I have seen used in human medicine for the treatment of seromas. The rationale is that heat will activate the blood circulation in the area and potentially activate resorption of the fluid. Even if it does not make a big difference, it gives the owners the impression they are doing something. I always tell them though that it is likely to get worse before it starts getting better, and that it will take several weeks to disappear completely. But as long as the swelling stays soft and painless, I tell them there is nothing to worry about.

Restricted exercise is important as well, as other have mentioned.

Re: How to deal with a seroma

Anthony Dennison — Wed, 30 Apr 2014 11:27:12 GMT

[quote user="Anthony Todd"]Sorry, I thought it said "post bitch spay"; didn't realise the seroma was back there........[/quote]

No you were right, it was post-bitch spay, but the original spay was prepubertal so the incision was a little more caudal than I normally do (on longer, because I couldn't find the blasted thing). The revision surgery created a much larger incision, more like an ex-lap wound, and all the muscle that was removed left alot of dead space.

Re: How to deal with a seroma

Anthony Todd — Wed, 30 Apr 2014 10:47:47 GMT

[quote user="Anthony Dennison"]It would be pretty hard to place a pressue bandage in this case as the seroma is in between the dog's legs[/quote]

Sorry, I thought it said "post bitch spay"; didn't realise the seroma was back there........

Legend has it that Gordon Knight, legendary surgeon at the RVC, used to treat a lot of things with PMI.

Policy of Masterly Inactivity, which was the code with us for many years. Of course all our seromas were gone within a week so that didn't apply.

Try pressure bandaging them, you'll be surprised, and no aggro from the owner either.

Re: How to deal with a seroma

Anthony Dennison — Wed, 30 Apr 2014 10:36:26 GMT

It would be pretty hard to place a pressue bandage in this case as the seroma is in between the dog's legs, hard place to keep a bandage on! A sample was taken for cytology which showed the occasional non-degenerate neutrophil, no bacteria or other sign of infection, so we're going for the benign neglect option (with a weekly check to make sure everything is progressing)

Re: How to deal with a seroma

Martin Atkinson — Wed, 30 Apr 2014 09:27:42 GMT

[quote user="Tim Charlesworth"]....seromas (being more general here) often occur in the higher mobility areas and as such can be difficult to bandage effectively. Of course, they shouldn't be going around the park if they are being strictly rested so hopefully this is less of a problem ..[/quote]It is difficult to apply pressure bandages at the best of times even in low mobility areas, unless you wrap it up like a mummy they slip and ruck up frequently end up causing more harm than good with rub sores. Plus it costs a fortune in bandages!

Re: How to deal with a seroma

Robin Grimmer — Wed, 30 Apr 2014 09:12:36 GMT

Normally drain them once or twice and then just leave them.

Re: How to deal with a seroma

Suzanne Kelly — Tue, 29 Apr 2014 23:07:47 GMT

+1 for benign neglect, they all go away on their own eventually even the huge ones.

Suzanne

Re: How to deal with a seroma

Glenn Hodgson — Tue, 29 Apr 2014 22:13:00 GMT

In my experience seromas just go away. Anything from 1 week for a lively cat spay to 6 months for a condylar lag screw. If very likely not an abcess I don't sample. Best to keep them not an abcess.

Occasionally dispense Nsaid if look like they are at all sore.

Haven't had any particularly upset owners. They are often pre warned about them depending on surgical area or boisterous nature of their pet.

Re: How to deal with a seroma

Glenn Hodgson — Tue, 29 Apr 2014 22:12:59 GMT

In my experience seromas just go away. Anything from 1 week for a lively cat spay to 6 months for a condylar lag screw. If very likely not an abcess I don't sample. Best to keep them not an abcess.

Occasionally dispense Nsaid if look like they are at all sore.

Haven't had any particularly upset owners. They are often pre warned about them depending on surgical area or boisterous nature of their pet.

Re: How to deal with a seroma

Anthony Todd — Tue, 29 Apr 2014 16:47:01 GMT

[quote user="Tim Charlesworth"]Nothing wrong with this but seromas (being more general here) often occur in the higher mobility areas and as such can be difficult to bandage effectively. Of course, they shouldn't be going around the park if they are being strictly rested so hopefully this is less of a problem ..[/quote]

Even I could bandage the middle of a dog and we kept all B/Ss on a lead for a fortnight anyway, too true, sometimes some Elastoplast fore and aft was needed.

I also think a bandage reminds the owner that the dog has had an op., and you're going to need to protect your Penrose drain and virtually any other procedure anyway.

PS A banadage helps with a repaired/drained aural haematoma too, and saves the Farrow & Ball....

You do need good sticky stretchy plaster for them though.

Re: How to deal with a seroma

Tim Charlesworth — Tue, 29 Apr 2014 16:40:49 GMT

[quote user="Anthony Todd"]

[quote user="Tim Charlesworth"] may take 4-6 weeks to resolve and the patient needs to be rested as much as possible. If the seroma fails to resolve then other options are drain placement or even omentalisation but the vast majority will resolve with conservative treatment.[/quote]

I'd say 4-6 days with a pressure bandage and it stops the owner ringing you 4-6 times daily and all the people in the park pointing out the dog has a lump and should be seen by a vet.

[/quote]

Nothing wrong with this but seromas (being more general here) often occur in the higher mobility areas and as such can be difficult to bandage effectively. Of course, they shouldn't be going around the park if they are being strictly rested so hopefully this is less of a problem ..

Re: How to deal with a seroma

Anthony Todd — Tue, 29 Apr 2014 16:26:01 GMT

I'd say 4-6 days with a pressure bandage and it stops the owner ringing you 4-6 times daily and all the people in the park pointing out the dog has a lump and should be seen by a vet.

Re: How to deal with a seroma

Anthony Dennison — Tue, 29 Apr 2014 12:18:41 GMT

Thanks for all the replies. I will pass these on, the dog in question is being seen at 3pm this afternoon.

Re: How to deal with a seroma

Tim Charlesworth — Tue, 29 Apr 2014 12:16:48 GMT

+1 to Stephen's comments. I think that you need to confirm it is a seroma (higher risk of infection if has had a repeat surgery) and if so then sit tight, may take 4-6 weeks to resolve and the patient needs to be rested as much as possible. If the seroma fails to resolve then other options are drain placement or even omentalisation but the vast majority will resolve with conservative treatment.

Re: How to deal with a seroma

Stephen Courtney — Tue, 29 Apr 2014 12:12:58 GMT

Seromas will resolve over 2-3 weeks. they first shrink, then go firm, then disappear.

If you keep sticking needles in them they will get infected. If you are sure a swelling is a seroma leave it alone. If you aren't sure an aseptic Fine Needle Aspirate to look for neuts and bugs is reasonable.

The most important thing is to communicate properly with the client so they know what to expect

Re: How to deal with a seroma

Francisco Gomez — Tue, 29 Apr 2014 11:29:24 GMT

[quote user="Anthony Dennison"]

which I managed to drain about half of at the end of last week using a syringe. It has since reformed.

[/quote]

Should you not consider (or have considered) to send the fluid for culture/analysis? And if it is indeed a seroma and nothing else you might just want to wait for it to be resolved.

I had once a very large seroma from a cystotomy op. It was so large that my first thought was that I had a breakdown from my abdominal layer. Nope! it was a simple seroma and resolved itself.

Re: How to deal with a seroma

Anthony Todd — Tue, 29 Apr 2014 11:05:29 GMT

[quote user="Martin Atkinson"]If you're sure its not infected I would drain it again then leave it to resolve - the owners probably won't appreciate a dripping drain![/quote]

I'd drain and pressure bandage, um, I was so terrified of eventration when I started that I pressure bandaged every bitch spay and always an ex.lap.

Pressure bandages on major abdo incisions make post op wounds heal so well with no ooze or drips and never a seroma [or a catastropic breakdown, not that any of you get those; ever....]

If you leave seromas without pressure they usually recur and/or just get bigger and the owner is never impressed.

Re: How to deal with a seroma

Martin Atkinson — Tue, 29 Apr 2014 10:57:57 GMT

If you're sure its not infected I would drain it again then leave it to resolve - the owners probably won't appreciate a dripping drain!. I guess there is a possibility you have a fistula through the abdominal wound and its peritoneal fluid so you may have to address that eventually