Chronic Encapsulated Seroma Persisting for Three Years after Abdominoplasty and a Successful Surgical Solution
Keywords:Pseudocapsule, Chronic seroma, Abdominoplasty, Capsulectomy, Surgery, Scarpaâ€™s fascia
AbstractAbdominoplasty is listed among five most common esthetic surgical procedures in the Western World. Despite all efforts, abdominoplasty bears a high risk of complications. We observed a 39-year-old-woman with previous classical abdominoplasty performed elsewhere three years ago. Clinical examination demonstrated a swollen and tense abdominal mass. Laboratory findings were normal. Clinical examination was completed by abdominal ultrasonography which demonstrated both, a significant fluid volume in this area and a dense fibrous â€œcapsuleâ€. The diagnosis was a late or chronic encapsulated seroma with a thick pseudocapsule or â€œbursaâ€. We performed a revision abdominoplasty with a standard supra-fascial dissection. Surgical resection of infra-umbilical flap containing skin, subcutaneous tissue and capsulectomy were performed under general anaesthesia. A new umbilicus was created attaching small skin flaps in the muscular fascia. No drains were used. We observed no seroma formation. Follow up after six and ten months was unremarkable. The fibrous pseudocapsule of chronic seroma results in different degrees of deformities, abdominal scar deviation and asymmetry. Surgical capsulectomy combined with revision abdominoplasty with preservation of Scarpaâ€™s fascia and placement of progressive tension sutures resulted in being effective and leads an esthetic outcome without seroma recurrence.
Matarasso A, Matarasso DM, Matarasso EJ. Abdominoplasty: classic principles and technique. Clin Plast Surg. 2014; 41(4):655-72. https://doi.org/10.1016/j.cps.2014.07.005 PMid:25283453
Molitor M, MÄ›Å¡Å¥Ã¡k O, Popelka P, VÃtovÃ¡ L, HromÃ¡dkovÃ¡ V, MÄ›Å¡Å¥Ã¡k J. Pulmonary embolism after abdominoplasty â€“ are we really able to avoid complications? Case report and literature review. Acta Chir Plast. Fall. 2016; 58(1):35-38.
Winocour J, Gupta V, Ramirez JR, Shack RB, Grotting JC, Higdon KK. Abdominoplasty: risk factors, complication rates, and safety of combined procedures. Plast Reconstr Surg. 2015; 136(5):597e-606e. https://doi.org/10.1097/PRS.0000000000001700 PMid:26505716
Massenburg BB, Sanati-Mehrizy P, Jablonka EM, Taub PJ. Risk factors for readmission and adverse outcomes in abdominoplasty. Plast Reconstr Surg. 2015; 136(5):968-77. https://doi.org/10.1097/PRS.0000000000001680 PMid:26505701
Baroudi R, Ferreira A. Seroma: how to avoid it and how to treat it. Aesthetic Surg J. 1998; 18:439. https://doi.org/10.1016/S1090-820X(98)70073-1
Roje Z, Roje Z, KaranoviÄ‡ N, UtrobiciÄ‡ I. Abdominoplasty complications: a comprehensive approach for the treatment of chronic seroma with pseudobursa. Aesthetic Plast Surg. 2006; 30(5):611-5. https://doi.org/10.1007/s00266-004-0142-1 PMid:16977373
Ardehali B, Fiorentino F. A meta-analysis of the effects of abdominoplasty modifications on the incidence of postoperative seroma. Aesthet Surg J. 2017; 37(10):1136-43. https://doi.org/10.1093/asj/sjx051 PMid:28482000
Pollock H, Pollock T. Progressive tension sutures: a technique to reduce local complications in abdominoplasty. Plast Reconstr Surg. 2000 Jun;105(7):2583-6; discussion 2587-8. https://doi.org/10.1097/00006534-200006000-00047 PMid:10845315
Arraiza M, Metser U, Vajpeyi R, Khalili K, Hanbidge A, Kennedy E, Ghai S. Primary cystic peritoneal masses and mimickers: spectrum of diseases with pathologic correlation. Abdom Imaging. 2015; 40(4):875-906. https://doi.org/10.1007/s00261-014-0250-6 PMid:25269999
Wollina U. Posttraumatic painful subcutaneous oily cysts. Cosmetic Medicine (International Issue). 2017; 3(1):25-6.
Wollina U, Heinig B, Langner D. Chronic expanding organized hematoma of the lower leg: a rare cause for nonhealing Leg ulcers. Int J Low Extrem Wounds. 2015; 14(3):295-8. https://doi.org/10.1177/1534734615571129 PMid:25691320
Pollock TA, Pollock H. Progressive tension sutures in abdominoplasty: a review of 597 consecutive cases. Aesthet Surg J. 2012; 32(6):729-42. https://doi.org/10.1177/1090820X12452294 PMid:22751080
Macias LH, Kwon E, Gould DJ, Spring MA, Stevens WG. Decrease in seroma rate after adopting progressive tension sutures without drains: A single surgery center experience of 451 abdominoplasties over 7 years. Aesthet Surg J. 2016; 36(9):1029-35. https://doi.org/10.1093/asj/sjw040 PMid:26977072
Khan UD. Risk of seroma with simultaneous liposuction and abdominoplasty and the role of progressive tension sutures. Aesthetic Plast Surg. 2008;32(1):93-9; discussion 100. https://doi.org/10.1007/s00266-007-9004-y PMid:17849158
Nasr MW, Jabbour SF, Mhawej RI, Elkhoury JS, Sleilati FH. Effect of tissue adhesives on seroma incidence after abdominoplasty: A systematic review and meta-analysis. Aesthet Surg J. 2016; 36(4):450-8. https://doi.org/10.1093/asj/sjv276 PMid:26821643
Di Martino M, Nahas FX, Kimura AK, Sallum N, Ferreira LM. Natural evolution of seroma in abdominoplasty. Plast Reconstr Surg. 2015; 135(4):691e-8e. https://doi.org/10.1097/PRS.0000000000001122
Caulfield RH, Maleki-Tabrizi A, Khan F, Ramakrishnan V. A large encapsulated seroma presenting as a mass 5 years post paraumbilical hernia repair. J Plast Reconstr Aesthet Surg. 2009; 62(1):105-7. https://doi.org/10.1016/j.bjps.2007.08.009 PMid:17933597
di Summa PG, Wettstein R, Erba P, Raffoul W, Kalbermatten DF. Scar asymmetry after abdominoplasty: the unexpected role of seroma. Ann Plast Surg. 2013; 71(5):461-3. https://doi.org/10.1097/SAP.0b013e3182503ad9 PMid:23143814
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