Taming the persistent seroma: multidisciplinary management following complex spinal revision surgery - a case report

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Wound Management

Background:

• Chronic seroma and pseudomeningocele formation are rare but challenging complications after spinal instrumentation, especially with prior infection and multiple revision surgeries.
• These complications have a high recurrence rate, posing significant therapeutic difficulties.

Purpose of the Study:

• To present a complex case of pseudomeningocele evolving into a persistent seroma with a cutaneous fistula after multi-level lumbar fusion.
• To review sclerotherapy protocols for managing such challenging postoperative wound complications.

Main Methods:

• A 75-year-old patient with a history of L3-S1 fusion developed a persistent pseudomeningocele and seroma post-revision surgery, complicated by Staphylococcus Epidermidis infection.
• Despite multiple surgical revisions and flap coverage, the seroma persisted, leading to the initiation of a multi-instillation doxycycline sclerotherapy protocol via a radiologically guided drain.

Main Results:

• Doxycycline sclerotherapy resulted in a progressive decrease in drain output, allowing for drain removal after 34 days.
• Follow-up ultrasound confirmed no significant fluid collection, and no recurrence of fistula or seroma was observed during the follow-up period.

Conclusions:

• This case underscores the difficulties in managing postoperative wound complications in spinal surgery, particularly with prior infection and suspected cerebrospinal fluid leaks.
• A pedicled SGAP flap offered durable coverage, and doxycycline sclerotherapy served as an effective salvage treatment for persistent seroma following failed surgical revisions.