Subcutaneous extension of perigraft seroma after thoracic aortic surgery - report of three cases
Tsutomu Doita1, Taro Yamasumi1, Yuki Nakamura1
1Department of Cardiovascular Surgery, Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Sakai, Osaka, 591-8025, Japan.
Background:
Subcutaneous extension of a perigraft seroma following thoracic aortic surgery is an infrequently encountered complication. For treatment, it is necessary to first exclude the possibility of perigraft fluid collection secondary to infection, a pseudoaneurysm, or impending rupture. However, it is difficult to diagnose collected fluid as indicative of a perigraft seroma, and there is also no standardized treatment for this condition.
Case Presentation:
Three patients who had undergone graft replacement of a thoracic aorta with arch reconstruction were referred to our department for findings of a subcutaneous tumor. In each, computed tomography showed perigraft fluid accumulation in the posterior sternum. In one, a subcutaneous tumor had appeared in the center area of the median sternotomy, 4 months after the operation. It was considered that a wound infection was the likely cause; thus, negative pressure wound therapy was started after incisional drainage and debridement. However, a fever developed 14 days after debridement, resulting in mediastinitis, the latter of which was assumed to be caused by a retrograde infection of the incisional wound. In the other two cases, a subcutaneous tumor appeared in the center of the median area of the sternotomy at 3 and 4 months, respectively, after the operation. In both, the tumor was treated with continuous drainage by aspiration with negative pressure, and cultures of drainage samples were negative for infection. Neither patient had a fever during hospitalization, and fluid collection disappeared during follow-up. In one of the latter two cases, a subcutaneous tumor formed again 3 months after drainage, which was treated in the same manner and subsequently disappeared. Thereafter, there was no recurrence noted at the 3-year follow-up examination.
Conclusion:
A perigraft seroma following thoracic aortic surgery, an infrequently encountered complication, has an appearance is similar to a subdermal tumor. Continuous aspiration drainage is a useful option for patients with no fever and negative for infection in drainage culture results.
Insights
Subcutaneous extension of a perigraft seroma after thoracic aortic surgery can mimic a subdermal tumor. Continuous aspiration drainage is effective for infected cases without fever.
Area of Science:
- Cardiovascular Surgery
- Surgical Complications
- Thoracic Aorta Surgery
Background:
- Subcutaneous extension of perigraft seroma is a rare complication after thoracic aortic surgery.
- Diagnosis can be challenging, requiring exclusion of infection, pseudoaneurysm, or rupture.
- No standardized treatment exists for this condition.
Purpose of the Study:
- To present cases of subcutaneous perigraft seroma following thoracic aortic surgery.
- To evaluate treatment options for this rare complication.
Main Methods:
- Case series of three patients with subcutaneous tumors post-thoracic aortic surgery.
- Computed tomography (CT) for diagnosis of perigraft fluid.
- Treatment included negative pressure wound therapy, incisional drainage, debridement, and continuous aspiration drainage.
Main Results:
- CT revealed perigraft fluid accumulation in the posterior sternum in all three patients.
- One patient developed mediastinitis after debridement for suspected infection.
- Two patients treated with continuous aspiration drainage had negative cultures and resolution of fluid collection, with one recurrence successfully managed.
Conclusions:
- Subcutaneous perigraft seroma can present as a subdermal tumor after thoracic aortic surgery.
- Continuous aspiration drainage is a viable treatment for non-infected seromas without fever.
