After third seroma repair (my 8th abdominal surgery), fistula developed in incision so there is always drainage from the small hole in my incision. I was told my choices are to live with it or have an extensive 4-5 hour surgery to remove every polyfilament suture that probably has bacteria that is causing the seromas/abcesses to develop. Do I have other choices? It was also suggested that cancer could possibly form at the sutures especially if those areas are consistently irritated.
Could Recurrent Seromas from Tummy Tuck Be Due to Bacteria in Polyfilament Sutures?
Doctor Answers 6
Recurrent seroma from sutures
First, I don't think you should worry about a cancer forming. Second, and more important, I think that you must have a chronic infection, not seroma. This is a big difference because most seromas, by definition, are not infected. If they were infected it would be called an abscess, or specified as an infected seroma. Most seromas can be easily and successfully treated as long as they are identified and tended to early. Chronic infection of sutures is certainly possible and I have seen one patient in over 20 years who had this. Once she had the surgery to lift up the skin and remove the infected sutures (yes they were polyfilament) she was "cured". Bacteria can hide and live within the nooks and crannies of the sutures. You could try a long course of antibiotics (say 6 weeks) but if it recurs after that, I would recommend surgery to be done with everything.
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Permanent sutures may become infected
Polyfilament sutures are braided, like a cable. They are more likely to become infected than monofilament sutures, which are a single solid strand. Either type of suture may be dissolvable or permanent. Dissolvable stitches may become infected but will deteriorate and eventually disappear if they do. Permanent stitches (either mono- or polyfilament) will have to be removed if infected, or the infection will persist. Surgery may be needed to remove permanent sutures from a tummy tuck.
Regarding seromas: seromas are fluid collections of serum (like blister fluid) in a wound. They are not uncommon after tummy tucks because there is a large space under the wound that may collect fluid, which is why drains are usually used. Sometimes the fluid acummulates after the drains are removed, forming a seroma. Perhaps your multiple surgeries contributed to this. Suture material is usually NOT an issue with a seroma. However, if permanent sutures (this is more important than poly- or mono-filament sutures) were used, they may become infected if the seroma does.
Seromas may be treated with serial aspiration (needle punctures every few days), replacement of a drain, incision/opening and wound packing, or excision of the lining of the seroma cavity. Packing is often a simple way to get rid of a seroma since it can be performed in the office, although dressings are inconvenient.
Discuss and clarify all these issues with your surgeon to see how they apply to you. Good luck and get better soon.
Seromas are not related to braided sutures, but persistent drainage from bacteria-contaminated sutures is a reality.
Your tummy tuck was complicated by seroma (serous fluid build-up beneath your skin flaps) either because there was no drain used (should have), the drain(s) were removed prematurely (sometimes happens to the best of us), or because escessive activity after partial healing and flap adherence was disrupted and a seroma cavity resulted (not the patient's "fault" but still sometimes happens). Seromas happen in some patients of all plastic surgeons who do lots of tummy tucks, and we all have similar but slightly different ways of dealing with this issue when it does happen.
Your case sounds unfortunately complicated by recurrent seromas requiring multiple failed attempts at closure and healing. During one of your operations, permanent braided sutures were used, subsequently became bacterially contaminated, and now you have a draining fistula. You may or may not still have seroma difficulties, but the bacteria residing in the interstices of the braided suture(s) are what cause the draining open wound. If one suture is the culprit, it needs removal.
However, if more than one braided suture is contaminated and involved in this draining problem, or perhaps now all of them are, then all of them will have to be removed in order to solve the issue. More and stronger antibiotics (even with infectious disease specialist consultation--this is done not only for expert help, but sometimes to transfer the problem to another doctor) will NOT work. This is a surgical problem and surgery is the only way to correct it.
Multiple contaminated sutures are, of course, a BIG deal, which is why surgeons are reluctant to admit this to the patient. It is also why many of us choose to utilize only monofilament sutures for our permanent suture choices, or choose to utilize only dissolving sutures at the initial operation. A whole discussion can be had about suture choices in various surgical situations, and there will be multiple opinions.
Cancer is so very, very low on the likelihood list it should not even be mentioned; this is a "red herring" that distracts from the real discussion that needs to be had--you need to have all of those contaminated sutures removed and get yourself healed. And this should be done sooner rather than later. Good luck and best wishes!
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Bacteria on Sutures used during Tummy Tuck Surgery?
It is not possible to give you precise advice without in-person examination and obtaining a full history. However, if you are experiencing repeated problems with abdominal wall sutures (for example those used to plicate abdominal wall muscles during tummy tuck surgery), then sometimes the only solution is to re-elevate the abdominal wall flap and remove all of the previously placed sutures.
I hope this helps.
Drainage after tummy tuck
If this is the first time you have had such a fistula, it may be that a single suture is the cause, and more often than not your surgeon may be able to remove it in the office using some local anesthesia. If many of your previous "redo" operations were related to draining sutures, it is most likely that these problems will continue until all the foreign material is removed.
It is possible, but very unlikely that a malignancy could develop at a site of chronic inflammation. It sounds like you gone through a lot more than you bargained for. I hope that whatever you choose solves this problem for you.
Seroms after Tummy Tuck
Pablo Prichard, MD