Wonder Wednesday: What was a seroma like?

This weeks Wonder Wednesday question is: What was a seroma like? 

***Graphic medical photos below***

As many of you know by now, I had a tummy tuck for lipedema removal on February 11th, 2021. Dr. Jaime Schwartz removed 3.5 feet of skin that weighed 20lbs. He also did manual extraction of the larger nodules and some liposuction as well. My stomach was almost all nodules and the removal of it was life changing. My back instantly felt better.

Top pics: Right before and after tummy tuck.
Bottom: Skin removed and nodules

About a week post op, I noticed when I leaned forward to pull my compression back up I was dripping from a non drain spot. I reached out right away to let the surgery tech know. I was advised to keep on eye on it but that it seemed like a seroma. A seroma is a collection of fluid that builds up under the surface of your skin. Seromas may develop after a surgical procedure, most often at the site of the surgical incision or where tissue was removed. The fluid, called serum, doesn’t always build up right away. I knew that a seroma was a possibility with any of plastic surgery. There was nothing myself or my surgeon did or didn’t do that caused the seroma.

February 21st – I went to my local ER to have the seroma drained as I was now soaking through 2 abd pads stacked on each other every 2 hours. My ER did a CT scan and felt I needed to go to a hospital in Pittsburgh that had a plastic surgery department. That hospital just told me to schedule an appointment at a local surgeon the next day.

Small section along my incision that was leaking

February 22nd – I went to a local Pittsburgh surgeon that had the worst “bedside” manner I’ve every dealt with. And I’ve exprienced a lot of shitty doctor appointments. This surgeon didn’t even introduce himself to me or look at the pin size opening. He just stated that he was going to need to cut me open hip to hip again to see what was going on and that he was going to “squeeze” me into his surgery schedule the next day. This instantly had me in tears. I was 11 days post op and emotionally exhausted. Once I was in the car, I reached out to Dr. Jaime’s office and gave them an update. I was advised to go see Dr. Gusenoff at UPMC in Pittsburgh. Dr. Jaime knows him personally and recommended him. Dr. Jaime reached out to Dr. Gusenoff and arranged for me to be seen the next day.

February 23rd – I had my first appointment with Dr. Gusenoff. His whole office was so sweet and understanding of my nerves and exhaustion. Dr. Gusenoff examined where I was leaking from and decided that I need to have the seroma opened and drained. While I was still pretty numb from the tummy tuck, he gave a little local to numb the area. Dr. Gusenoff then cut open a 5in across incision. I joked that I felt like I had a c-section and was left open. After the incision was open they jiggled my stomach to help drain the fluid before flushing it out to clean it. I was then shown how to pack it with saline soaked gauze twice daily. I did not think I’d be able to handle packing my own wound. But I did it. It was the creepiest thing I’ve ever had to do. There was just something weird about being able to feel that deep into your own abdomen.

Top: incision opened to drain seroma
Bottom: gauze packing

March 8th – After two weeks of packing the wound, Dr. Gusenoff switched me over to a wound vac. The wound vac foam got changed 3 times a week by an amazing home health nurse. A wound vac is a piece of foam trimmed to fit into the wound which is then covered by drape that gives it an air tight seal. A piece of tubing connects from the foam to a small portable vacuum machine. This sucks out the extra fluid and causes negative pressure allowing the wound to heal from the inside out. I thought it was going to be super annoying but it was the easiest thing. For the first time in weeks I didn’t feel all gross as the wound vac allowed me to take a real shower. After the 24 hours of the wound vac I had two little areas start to leak along my incision above each thigh. Those two wounds were deep enough that they needed to be packed with 1/4″ gauze strips that I called straw wrappers. While the day to day with the wound vac was pretty easy, the removal of the draping can be rough on sensitive (ginger) skin. Using adhesive remover wipes and skin prep made it a more gentle process. The resident at Gusenoff’s office didn’t think I needed the adhesive remover and just pulled the draping. And then was surprised when my skin showed instant reaction.

Wound vac placement and a full cartridge

March 23rd – Just 2 short weeks of the wound vac and Dr. Gusenoff felt the wound was now small enough to heal with Aquacel & Duoderm combination. Aquacel is a moisture-retention dressing that consists of soft non-woven sodium carboxymethylcellulose fibers which forms a gel on contact with wound fluid. The gel promotes a moist wound-healing environment yet retains wound exudates by vertical absorption. DuoDERM® Hydrocolloid is an occlusive gel dressing that helps maintain a moist wound bed. To maintain the wound with the Aquacel & Duoderm was simple. I just had to cut a strip of the Aquacel to lay across the opening and then cover it with a Duoderm patch. That was changed every other day.

Irritated skin from drape removal. Aquacel & Duoderm wound care

April 13th – No more need for a moist healing! Dr. Gusenoff treated the now shallow wound with a silver nitrate stick which acts as a cauterizing agent. This forms a silver-ish or black scab. I was to keep it dry for 48 hrs to form a good scab. Then I was able to wash it while in the shower. After it was thoroughly dry I just protected it with an abd pad.

Wound treated with silver nitrate

May 7th – Its closed!!! Something I felt was never going to heal closed up in 11 weeks. Megan at Dr. Gusenoff’s office said it looked great. She said that I was cleared from having to check in with them and after 2 more weeks I’d be ok to start soaking in bubbles baths again.

Wound closed!

I am so incredibly grateful to have such knowledgeable doctors such as Dr. Jaime and Dr. Gusenoff to help me heal without any complications. I was so worried about infection as it was such a big wound (for me). I’m thankful for the surgery tech that let me send weekly (if not more often) photos and updates on how I was healing. I never once felt like I was going through this new experience alone.

I would 100% have the tummy tuck again even knowing I’d have to pack a wound. The relief from pain and energy I’ve gotten back since the surgery is worth the extra steps of healing a seroma.

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