Management of chronic abdominal wall seroma with Doxycycline sclerotherapy using a Negative Pressure Wound Therapy System KCI-V.A.C.Ulta™-A case report

Abstract

Introduction: Seroma is a common and challenging post-operative complication that surgeons are often faced with after performing procedures in which tissue dead spaces have been created. The management strategies consist of non-operative management, percutaneous drainage, or surgical drainage. Our case report discusses the use of Doxycycline sclerotherapy in the successful resolution of a chronic abdominal wall seroma.

Presentation of case: We present the case of a 50 year old patient with extensive history of multiple abdominal surgeries, including appendectomy, multiple hernia repairs with recurrent mesh replacement as a result of infection followed by post-operative formation of seroma after each repair. Recently, patient underwent panniculecotomy complicated by seroma that was successfully resolved with the use of doxycycline sclerotherapy.

Discussion: Sclerotherapy has been used previously in the surgical field such as thoracic surgery, as a successful use of sclerosants in chronic pleural effusions has been documented. Sclerosants range from talc, tetracycline antibiotics, ethanol, polidocanol, erythromycin, OK-432, fibrin glue, and povidone-iodine, and are largely safe and easily applicable. Doxycycline in particular can be a simple and effective method for resolution of chronic seroma. This case demonstrates the successful use of doxycycline in the resolution of a chronic abdominal wall seroma.

Conclusion: Chronic and recurrent seroma after surgery can be difficult to deal with. Using sclerosants such as Doxycycline would be an effective solution to treat this chronic issue and to prevent its recurrence especially if it is used with a Negative Pressure Wound Therapy System.

Keywords: Abdominal wall; Fluid collection; Sclerosant; Sclerotherapy; Seroma.

Fig. 1

Intraoperative image demonstrating area of panniculectomy. Cranial is on the left side of the image. Caudal is on the right side.

Fig. 2

Post-operative Day #5 demonstrating close re-approximation of the wound with ABRA® device.

Fig. 3

Day 4 post doxycycline wound VAC application. This image shows four retention sutures on both sides of open abdominal wound present; staples present on lateral edges of incision; open wound approximately 16.5 × 5 cm – beefy red with no purulent drainage; site of point tenderness proximal to open wound; bowel sounds present.

Fig. 4

Shows wound size reduced dramatically from 16.5 cm × 5 cm to 7 cm × 1 cm in the office visit after one month of the ER visit.

Fig. 5

Substantial wound healing five months after the first Doxycycline sclerotherapy.