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How Do We Resolve This Seroma?

I had an incisional median hernia repair, component separation and a double layer of Permacol inserted, resulting in a "seroma" the size of my abdomen, skin and bellybutton detached from the muscle layer, recurrence of the hernia, and bulging of muscles on the right side aches on walking. I'm allergic to rubber and have discovered that Permacol is cross linked with polyurethanes (diisocyanates), and does not resorb. Biomaterial was used to avoid rubber chemicals.

Doctor Answers (5)

Get other opinions for tummy tuck complications.

+2

Hi.

Sounds really difficult. You need two other opinions about how to proceed.  First, I would recommend an interventional radiologist to drain the seroma.


Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Failed Hernia Repair

+2

A repeat hernia repair is best performed after at least 9 months since your last intra-abdominal procedure because the adhesions to the bowel are easier and safer to handle.

Your components separation most likely has been maintained and will not be repeated.

You will need the seroma and hernia sack removed, the appropriate mesh needs to be placed as well as plenty of drains to minimize fluid build up and to allow the skin, fat and muscle to heal together.

Good luck.

Morgan E. Norris, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 18 reviews

Large Seroma after Components Separation and Midline Hernia Repair

+2

Permacol is a porcine acellular graft used for strength and claimed by the distributor to be more likely to retain strength than human acellular dermal autograft. Whoever is taking care of you will likely be considering how to avoid  recurrence after what sounds like a very thoughtfully planned operation. 

Seromas are treated by drainage, until they stop filling up. This is the routine procedure if they occur after a tummy tuck. Studies find an average of 3.5 aspirations to resolve them. If aspiration does not work, and I am referring to the immediate post-op period of 1-3 weeks, not months later, then a seroma-catheter can be placed to re-establish drainage.  If this does not work, then a lining has most likely formed around the seroma, and we now have what is called a bursa, a fluid-filled fibrous cavity.

Treatment for bursas is re-operation or sclerosis. Sclerosis means instilling a chemical agent that irriates the lining and makes it stick together, obliterating the cavity. Doxycycline (similar to tetracycline) is one agent used.

If that does not work, then surgical removal of the lining tissue is necessary. If the biological reinforcement has failed and the hernia has recurred, then an alternative for hernia repair will need to be found, such as a re-repair of the components of the abdominal wall in the midline, and an alternative mesh or mesh substitute.  

With tummy tucks, quilting sutures that re-attach the abdominal skin/fat flap back down to the abdominal wall are very effective in preventing seromas, even without drains. This might be helpful in a case like yours.

What is important is that you have confidence in your surgeons, who having undertaken your complicated initial surgery, are likely to be very well-versed in the techniques and literature pertaining to handling these difficult problems. You would be able to get specific answers to your particular situation from them, whereas in a forum like RealSelf, we can only offer non-specific information that may or may not be relevant to your particular case.

With persistence, these kinds of problems are usually corrected.

If you follow this link, you will find many articles addressing this problem:

 

 

Robert M. Lowen, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 26 reviews

How Do We Resolve This Seroma?

+2

This is obviously a complex problem, and there is not enough info here to make any firm recommendation. When was the surgery? Were there drains? Has this been aspirated? Has a new drain been inserted? Has there been an attempt at sclerosis? How do you know that the hernia has recurred? 

It is not too likely that without further info that you will get much usable advice online. Seeing you surgeon is where you should start, and if you are not content with the treatment plan, a second opinion would be completely appropriate. 

Thank you for your question, all the best.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 34 reviews

Seroma after Component Separation

+2

    The component separation technique is preferred over mesh techniques and has been one of the more successful innovations in the field of hernia repair. However, the issue of seroma in your case must be addressed.  This is a complex issue that needs to be addressed by the surgeon or surgeons who performed the operation. 

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 239 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.