Ask Dr Gary: Draining eases pain of lump

This week a patient came to me with a painful lump on her abdomen, just under her surgical scar where the previous week she'd had surgery. She was experiencing one of the most common surgical complications, a seroma.

When surgeons are finished with an abdominal surgery, they close the deep inner layer of fascia (the tough fibrous connective tissue that surrounds muscles) with a row of strong synthetic stitches. They tightly close the outer layer, the skin, with stainless steel staples.

But the stuff in between, the fatty layer between skin and muscle, is harder to get closed.

Staples and glues don't work on fat. Surgeons can sometimes try stitching the fat together, or placing drains that siphon off liquids externally. Despite this, seromas can still form.

If you're thin, this is usually no problem, the fluid resorbs, and the wound heals together in a few weeks. But if you're overweight or obese, as 65 per cent of us are, or just unlucky, this cut fat may just sit there, oozing fluid which has no place to escape.

This collected fluid pushes the tissues apart and impedes healing.

Eventually it creates a hard and painful lump beneath an otherwise healthy wound: a seroma.

Some seromas will become inflamed, large and painful. These are the ones we drain to ease pain, speed healing and, theoretically at least, prevent the fluid from becoming infected.

Patients are frequently surprised at the primitive but effective technique for treating seromas: doctors remove a few staples, gently pry apart a few centimetres of the freshly healed skin wound with their fingers, and let the fluid out. Surprisingly, it doesn't hurt much. Sometimes a few millilitres trickle out, other times it's a big seroma and liquid gushes out by the cupful. When that happens, patients wonder if things are okay in there, but a quick exam will prove that their innards are still safely under their abdominal muscles and their fascial layer is intact.

Drained of its fluid, the seroma usually disappears, the fat heals, and the skin closes. Seromas can recur, but that's not common, especially if a little bit of the wound can be left open to allow continued drainage.

Gary Payinda, MD, is an emergency physician who would like to hear your medical questions. Email drpayinda@gmail.com (This column provides general information and is not a substitute for the advice of your doctor.)