QuestionI would like to know more about seroma that result because of an injury, what to do about it in particular.
Here's my story - About 5 weeks ago, I fell and my shin landed on a metal bar, just missing a direct hit to the knee. Xray was negative for fracture. I developed what was orginally thought to be a hematoma approximately 3"x8" diagonally across my leg starting about 2" left of the tibia, just below the knee joint, and running diagonally toward the joint, ending parallel and to the outside of the kneecap. The fluid pressure in this hematoma had increased to the point where the skin was very tight, with a waterbed sort of fluctuation to it when it was pressed on, so I went back to the dr's office, where one of my dr's colleagues removed 40cc of serous, yellow, transparent fluid from what is apparently a seroma instead of a hematoma. I continue to have fluid build back up in it. I wonder, if the skin layers cannot contact the underlying tissue because of the fluid, will that keep it from resolving? One week after the first aspiration, another 20cc was removed. I've tried keeping a compression wrap on it to slow refilling, but that has not made much of an impact. There is less fluid present, but it still tries to refill.
The dr I see continues to say that nothing needs to be done about it, but I wonder about that, given the length of time that it has continued to exist. I cannot find useful information online regarding seroma caused by trauma in people, where an implant or some kind of surgery was NOT involved.
Can you offer some advice on what I need to be aware of or suggest my dr might do to get this seroma healed up? He doesn't seem to have a plan besides wait and do nothing. it took complaining 3 times over a week and a half to get it aspirated the first time. What kind of doctor would be an appropriate choice for a second opinion?
I have significant medial OA in my knee, and need to wear my unloader brace, but cannot because the brace calf shell rests on the front of my shin where the lower portion of the seroma is.
If you can point me in the direction of some material to read regarding this problem as well as some thoughts on what might be done about it, I'd appreciate it. This problem seems to be somewhat unusual as an impact caused it, instead of a surgery or implant, maybe that's confusing how to treat it? I'm trying to get more informed, so that I can make sure that I get the neecessary care for this seroma.
AnswerVery nice description of the problem for a non-medical person! These can be frustrating. Traumatic seroma-injury caused inflammation, inflammation caused fluid formation, fluid formation formed a track/space, and now, with drainage, there is a space with negative pressure, where fluid can re-accumulate. These can be frustrating, because they tend to recur. Drainage is temporary, and there is a small, but real chance of contaminating this sterile fluid and creating an infection. That may be why your MD is reluctant to continue to drain it. I like to drain it to get the diagnosis, ie., exclude blood or infection in the fluid, then to drain as best as I can, then wrap it pretty firmly with an ace, to try to prevent re-accumulation of the fluid. Being on NSAID's- Motrin and others may help. Also, ice- ice cubes in a baggie, on for 20 minutes, then off for 2 hours will block some of the inflammatory response and re-accumulation of fluid. If I felt referral was necessary, then Orthopedics is my first choice. If there were other types of arthritis involved like rheumatoid or lupus or others, then Rheumatology would be my other choice for referrals.
Bottom line, consider one more aspiration, then wrap tightly with Ace, use the ice, use the anti-inflammmatory meds (NSAIDS or COX-2's [celebrex, vioxx, bextra]) and then refer if no better.
