A 57-year-old Caucasian female who had undergone laparoscopic Roux-en-Y gastric bypass for morbid obesity with subsequent bilateral medial thigh lifts 2 years later, had been referred for chronic seromas at both thigh lift incision sites. Previous non-operative approaches, including aspiration with drainage and injection of sclerosing agents had failed to control the seromas. She then underwent surgery 8 months after the original thigh lifts, with obliteration of bilateral seroma cavities. The linings of both seroma cavities were stripped and quilting sutures placed to minimize the dead space. Unfortunately, the seromas recurred and she was re-operated on 2 years later.
The seromas were excised bilaterally (), however, this time dermal flaps were created measuring >30 cm on the left side and 20 cm on the right side ( and ). The flaps were de-epithelialised, tucked into the site of the seroma cavity, and sutured with Vicryl sutures ( and ). Complete haemostasis was obtained, and the incisions were closed using simple nylon sutures. The patient tolerated the procedure well. The rationale behind the surgery was that if the seroma recurred, the dermal flap would absorb the seroma fluid via dermal lymphatics. This technique has long been used in the treatment of severe lymphedema secondary to filiariasis and was first described by Thompson nearly 40 years ago.2
Figure 1 Diagram of the procedure. The seroma was located at the incision site of a medial thigh lift (A). The seroma cavity was excised (B), and a de-epithelialised dermal flap created to obliterate dead space and increase lymphatic flow (C). The flap was tucked (more ...)
Intraoperative photographs of the excised seroma cavity (A) and de-epithelialised dermal flap used to fill the defect (B).
A few months later, the patient re-presented for smaller re-accumulations of fluid, measuring ~7 cm bilaterally. The seroma cavities, which were at the lower end of the thigh incisions, were excised in toto. Again, dermal flaps of tissue were created to both obliterate the defects as well as provide additional lymphatic flow. The flaps were de-epithelialised, placed into the wall of the seroma cavities, and secured with Vicryl sutures. The incisions were then closed in multiple layers without a drain, with pressure dressing applied.