Surgery and Hospitalization
What is a seroma?
What is the difference between a seroma and a hematoma?
Asked in Surgery and Hospitalization
What is the difference between seroma versus hygroma?
Asked in The Difference Between
What is the difference between seratoma and ceratoma?
Asked in Surgery and Hospitalization
What risks are associated with abdominoplasty?
Asked in Health
What is a serouma?
Seroma is a clear pocket of serous fluid that can develop in the body after surgery (especially after a mastectomy.) Some women will need repeated visits to their doctors to have seroma fluid drained (aspiration.) Small blood vessel are ruptured (blood plasma) can seep out and cause inflammation caused by dying cells. Seromas can be sometimes caused by injury from a blow that starts to swell.
Asked in Surgery and Hospitalization
What does it mean if you have a lump on your belly button after having an umbilical hernia surgery?
Asked in Liposuction
What is liposuction and what are the risks involved?
Asked in Liposuction
What are the possible complications involved in a tummy liposuction surgery?
What are some of the risks involved with cosmetic plastic surgery?
Asked in Dog Health
What are the swollen nodules at healing site of spay incision?
What are negative consequences of cosmetic surgery?
Asked in Domestic Dogs, Dog Training, Dog Behavior
Can you neuter a older dog?
Asked in Surgery and Hospitalization
What are the dangers of augmentation surgery?
Some common dangers of augmentation surgery are Hematoma, where a pocket of blood forms in the surgical wound. Seroma, a form of "blister fluid" forming around the implants and Hypertrophic Scarring which is where thick red scarring forms after surgery. Other common risks are infection, as apparent with any surgery and in very rare cases, Mondor's Disease.
Is a hard lump normal after a bilateral mastectomy?
Hard lump? Any lump(s) found after a mastectomy could be troublesome. It may be a hematoma (collection of blood), a seroma (collection of fluid), an infection, a cyst, swelling, left over tissue..or a host of other things. It may be reabsorbed by the body, something to live with or cause a problems. Best let your doctor check it out; especially if it's tender!
Asked in Cosmetic Surgery
Could you get nerve damage from a tummy tuck?
You absolutely can get nerve damage from a tummy tuck and I know this to be fact first hand. I have no feeling from my belly button to my incision line due to the PS cutting a major nerve in that area. I knew that was a risk when I signed up but it is a very odd feeling that I have to now deal with for the rest of my life. Also developed a seroma immediately after surgery. Just consider all scenarios before going under the knife.
What effects come with cosmetic surgery?
The positive effects of cosmetic surgery include increased self confidence and , in many cases, clear physical improvement. On the downside all cosmetic surgery carries risks and complications. These risks and complications are a part of all surgucal procedures. Such examples would be infection, haematoma, seroma. Also, many people who have cosmetic surgery have unrealistic expectations and end up not being happy afterwards. Today Plastic Surgeons are very careful not to accept Patients who make unrealistic demands from cosmetic surgery
Asked in Dog Health, Veterinary Medicine
My dog hit his head and now has a bump that wont go away?
This is likely a seroma or hematoma; less likely would be a cartilage or bony callus. If your dog is otherwise find (walking straight, eating normally, playing, etc), you can keep an eye on it over the next few weeks and see if it goes away. If not, your dog may have a new bump, but it shouldn't cause any problems. However, if your dog is having trouble walking, can't see well, isn't eating well or otherwise is acting 'wrong' - take him to a veterinarian immediately as he could have pressure on his brain.
What are the risks of cosmetic surgery?
There are risks with all cosmetic surgery procedures. These should be fully explained to you by your Plastic Surgeon at the consultation. Each particular operation carries its own risks of course, but generally speaking there are risks associated with anaesthesia for which you will be screened prior to surgery. In terms of the surgery, then the usual risks of any surgery apply, these are, but not limited to, bleeding haematoma seroma infection swelling and bruising ( very likely in most cases ) skin necrosis poor healing of the scars Of course, there is always a risk that the results of the surgery may not turn out as intended. The above risks maybe a contributory factor. Sometimes cosmetic surgery has to be repeated to get the results originally anticipated
Asked in Surgery and Hospitalization
Most common cause of fever after surgery?
Post Operative Fever Causes of Fever (think of five W's: Wind, Water, Wound, Walking, Wonderdrug) Workup: CBC with differential, CXR, 2 blood cultures, UA, Urine Cx 1) Atelectasis (POD 1-2) a. Most common cause of post-op fever b. Risk factors: prolonged immobilization, smoking hx, lung dz c. Sx: low grade fever, rales on auscultation, tachycardia, tachypnea d. Tx: bronchoscopy 2) Pneumonia (POD 1-2) a. Risk factors: i. Respirator use (Pseudomonas, Klebsiella) 1. Tx: aminoglycosides + penicillin ii. Aspiration 1. Tx: NGT for decompression, oxygenation b. Sx: cough, sputum production; Vitals: fever, ↑ RR c. Findings: CXR infiltrate, Leukocytes on CBC 3) UTI (POD3+) a. 5% chance per each day foley is in b. Sx: burning sensation upon urination; no pain if Foley still in c. Risk factors: prostate hypertrophy, diabetes, catheters, urinary retention d. Microorganisms: Pseudomonas, Serratia, Enterococcus, E.Coli, Proteus, Klebsiella e. Findings: leukocyte esterase and nitrite changes on UA; growth on Urine Cx, leukocytes on CBC f. Tx: remove foley, increase fluids, Abx 4) Wound (POD 5+) a. Sx: >2cm erythema, swelling, warmth, pain around incision site b. Microorganisms: Staph most common c. GI infections: E. coli, Bacteroides, Enterococcus d. GU infections: Pseudomonas, Proteus e. Tx: drain and wet-to-dry dressings twice daily f. Other complications: hematoma, seroma, dehiscence (fascial opening) 5) DVTs (POD7+) a. Sx: leg edema, tender superficial veins, chest pain, tachycardia, tachypnea, SOB b. Studies: Doppler, venogram, CT (look for occlusion in pulmonary arteries) c. Tx: ambulate, SCDs, systemic heparin, consult cardio 6) Medications - drug rxn can occur anytime 7) Line infections a. IV lines need to come out after 72hrs b. Sx: fever, leukocytosis on CBC, bacteremia on blood Cx, (+) culture from line tip c. Micro: S. aureus, S. epidermidis d. Tx: removal of line and +/- IV Abx 8) Peritonitis a. Perforation of GI tract à abdominal pain, fever, sepsis b. Studies: KUB (check for free air) c. Tx: NPO with NGT, Abx, IVF, operate to irrigate abdomen d. Complications: abscess formation i. Tx: localize with CT scan or Gallium study (xrays while injecting radioactive gallium into bloodstream), drain, Abx Fever occurring during operation 1) Transfusion rxn a. Sx: fever, excess bleeding, urticaria, red urine b. Tx: stop transfusion, hydrate with NS, mannitol for osmotic diuresis 2) Intraoperative Septicemia a. Release of abscess b. Tx: copious irrigation 3) Malignant hyperthermia a. Sx: fever, tachycardia, tachypnea, acidosis with hyperkalemia, shock b. Causes: halothane, succinylcholine, MAOi + meperidine c. Tx: i. stop surgery/anesthesia ii. dantrolene (muscle relaxant) iii. cool patient iv. hyperventilate to ¯ acidosis v. bicarb + insulin to ¯ hyperkalemia and ¯ acidosis vi. mannitol for diuresis d. mortality 60% Fever occurring few hours post-op 1) Thyroid storm 2) Addisonian crisis a. Tx: resume steriod therapy for Addison's dz 3) EtOH withdrawal a. Sx: low grade fever, tremors, seizures b. Wernicke's encephalopathy: confusion, nystagmus, ataxia c. Korsakoff's: confabulation, amnesia caused by damage to mamillary bodies d. Tx: thiamine 4) Anastomotic leak 5) Clostridium perfringens wound infection
Asked in Human Anatomy and Physiology
What is another name for chest tube that provides continuous drainage?
A chest tube (chest drain or tube thoracostomy in British medicine or intercostal drain) is a flexible plastic tube that is inserted through the side of the chest into the pleural space. It is used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter. Contents [hide] 1 Indications 2 Contraindications 3 Technique 4 Chest Drainage Canister 5 Complications 6 References 7 External links Indications Pneumothorax: accumulation of air in the pleural space Pleural effusion: accumulation of fluid in the pleural space Chylothorax: a collection of lymphatic fluid in the pleural space Empyema: a pyogenic infection of the pleural space Hemothorax: accumulation of blood in the pleural space Hydrothorax: accumulation of serous fluid in the pleural space Contraindications Contraindications to chest tube placement include refractory coagulopathy, lack of cooperation by the patient, and diaphragmatic hernia. Additional contraindications include scarring in the pleural space (adhesions) Technique The insertion technique is described in detail in an article of the NEJM. The free end of the tube is usually attached to an underwater seal, below the level of the chest. This allows the air or fluid to escape from the pleural space, and prevents anything returning to the chest. Alternatively, the tube can be attached to a flutter valve. This allows patients with pneumothorax to remain more mobile. British Thoracic Society recommends the tube is inserted in an area described as the "safe zone", a region bordered by: the lateral border of pectoralis major, a horizontal line inferior to the axilla, the anterior border of latissimus dorsi and a horizontal line superior to the nipple. More specifically, the tube is inserted into the 5th intercostal space slightly anterior to the mid axillary line. Chest tubes are usually inserted under local anesthesia. The skin over the area of insertion is first cleansed with antiseptic solution, such as iodine, before sterile drapes are placed around the area. The local anesthetic is injected into the skin and down to the muscle, and after the area is numb a small incision is made in the skin and a passage made through the skin and muscle into the chest. The tube is placed through this passage. If necessary, patients may be given additional analgesics for the procedure. Once the tube is in place it is sutured to the skin to prevent it falling out and a dressing applied to the area. Once the drain is in place, a chest radiograph will be taken to check the location of the drain. The tube stays in for as long as there is air or fluid to be removed, or risk of air gathering. Chest tubes can also be placed using a trocar, which is a pointed metallic bar used to guide the tube through the chest wall. This method is less popular due to an increased risk of iatrogenic lung injury. Placement using the Seldinger technique, in which a blunt guidewire is passed through a needle (over which the chest tube is then inserted) has been described. Chest Drainage Canister A chest drainage canister device is typically used to drain chest tube contents (air, blood, effusions). There are generally three chambers. The first chamber is a collecting chamber. The second is the "water seal" chamber which acts as a one way valve. Air bubbling through the water seal chamber is usual when the patient coughs or exhales but may indicate, if continual, a pleural or system leak that should be evaluated critically. It can also indicate a leak of air from the lung. The third chamber is the suction control chamber. The height of the water in this chamber determines the negative pressure of the system. Bubbling should be kept a gentle bubble to limit evaporating the fluid. Increased wall suction does not increase the negative pressure of the system. Newer systems are designed not to need the water seal chamber, so there is not a column of water that can spill and mix with blood, mandating the replacement of the canister. Even newer systems are smaller and more ambulatory so the patient can be sent home for drainage if indicated. Complications Major complications are hemorrhage, infection, and reexpansion pulmonary edema. Chest tube clogging can also be a major complication if it occurs in the setting of bleeding or the production of significant air or fluid. When chest tube clogging occurs in this setting, a patient can suffer from pericardial tamponade, tension pneumothorax, or in the setting of infection, an empyema. All of these can lead to prolonged hospitilization and even death. To minimize potential for clogging, surgeons often employ larger diameter tubes. These large diameter tubes however, contribute significantly to chest tube related pain. Even larger diameter chest tubes can clog. In most cases, the chest tube related pain goes away after the chest tube is removed, however, chronic pain related to chest tube induced scarring of the intercostal space is not uncommon. In recent years surgeons have advocated using softer, silicone Blake drains rather than more traditional PVC conventional chest tubes to address the pain issues. Clogging and chest tube occlusion issues have been a problem, including reports of life threatening unrecognized bleeding that occurs in the chest due to an occluded or clogged drain. Thus when a chest tube is inserted for whatever reason, maintaining patency is critical to avoid complications. Injury to the liver, spleen or diaphragm is possible if the tube is placed inferior to the pleural cavity. Injuries to the thoracic aorta and heart have also been described. Minor complications include a subcutaneous hematoma or seroma, anxiety, shortness of breath (dyspnea), and cough (after removing large volume of fluid). Subcutaneous emphysema indicates backpressure created by a clogged drain or insufficient negative pressure.
Breast reconstruction - natural tissue?
Definition After a mastectomy, some women choose to have cosmetic surgery to remake their breast. This type of surgery is called breast reconstruction. During breast reconstruction therapy using natural tissue, the breast is reshaped using muscle, skin, and fat from another part of your body. This surgery can be performed at the same time as mastectomy or later. Alternative Names Transverse rectus abdominous muscle flap; TRAM; Latissimus muscle flap with a breast implant; DIEP flap; Gluteal free flap Description If you are having breast reconstruction at the same time as your mastectomy, your surgeon may do a skin sparing mastectomy. This means only the area around your nipple and areola is removed, and more skin is left to make reconstruction easier. If you will have breast reconstruction later, your surgeon will remove enough skin over your breast to be able to close the skin flaps. The two most common methods of breast reconstruction are transverse rectus abdominous muscle flap (TRAM) and latissimus muscle flap with a breast implant. For both of these procedures, you will have general anesthesia (asleep and pain-free) For TRAM surgery: Your surgeon will make a cut across your lower belly, from one hip to the other. Your scar will be hidden later by most clothing and bathing suits. Your surgeon will loosen skin, fat, and muscle in this area. The surgeon will then tunnel this tissue under the skin of your abdomen up to the breast area. Your surgeon will use this tissue to create your new breast. Blood vessels remain connected to the area from where the tissue is taken. In another method, the skin, fat, and muscle tissue are removed from your lower belly. Then the surgeon places this tissue in your breast area to create your new breast. In this method, the arteries and veins are cut and reattached to blood vessels under your arm. This tissue is then shaped into a new breast. Your surgeon will match the size and shape of your remaining natural breast as closely as possible. Your surgeon will close your belly cut with stitches. If you would like a new nipple and areola created, you will need a second, much smaller surgery later. For latissimus muscle flap with a breast implant: Your surgeon will make a surgical cut in your upper back, on the side of your breast that was removed. Your surgeon will loosen skin, fat, and muscle from this area and then tunnel this tissue under your skin to the breast area. This tissue will be used to create your new breast. Blood vessels will remain connected to the area from where the tissue was taken. This tissue is then shaped into a new breast. Your surgeon will match the size and shape of your remaining natural breast as closely as possible. An implant may be placed underneath the chest wall muscles to help match the size of your other breast. If you would like a new nipple and areola created, you will need a second, much smaller surgery later. When breast reconstruction is done at the same time as a mastectomy, it adds about 2 to 4 hours to the surgery. When it is done as a second surgery, it may take more than 2 or 6 hours. Why the Procedure Is Performed You and your doctor will decide together about whether to have breast reconstruction, and when. The decision depends on many different factors. Having breast reconstruction does not make it harder to find a tumor if your breast cancer comes back. The advantage of breast reconstruction with natural tissue is that the remade breast is softer and more natural than breast implants. The size, fullness, and shape of the new breast can be closely matched to your other breast. But muscle flap procedures are more complicated than placing breast implants. You may need blood transfusions during the procedure. You will usually spend 2 or 3 more days in the hospital after this surgery compared to other reconstruction procedures. Also, your recovery time at home will probably be longer. Many women choose not to have breast reconstruction or implants. They may use a prosthesis (an artificial breast) in their bra that gives a natural shape, or they may choose to use nothing at all. Risks Risks for any surgery are: Blood clots in the legs that may travel to the lungs Blood loss Breathing problems Heart attack or stroke during surgery Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney Reactions to medicines The risks for breast reconstruction with natural tissue are: Loss of sensation around the nipple and areola Noticeable scar One breast is larger than the other (asymmetry of the breasts) Skin loss or chronic wounds on the chest wall There is also a risk of bleeding into the area where the breast used to be. Sometimes a second operation is needed to control this bleeding. Before the Procedure Always tell your doctor or nurse if you are taking any drugs, supplements, or herbs you bought without a prescription. During the week before your surgery: Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot. Ask your doctor which drugs you should still take on the day of your surgery. On the day of your surgery: Do not eat or drink anything after midnight the night before surgery. Take your drugs your doctor told you to take with a small sip of water. Shower the night before or the morning of surgery. Your doctor or nurse will tell you when to arrive at the hospital. After the Procedure You will stay in the hospital for 2 to 5 days. You may still have drains in your chest when you go home. Your surgeon will remove them later during an office visit. You may have pain around your cut after surgery. Fluid may collect under the skin of your armpit. This is called a seroma. It is fairly common. Seromas usually go away on their own, but sometimes they need to be drained. Outlook (Prognosis) Results of reconstruction surgery using natural tissue are usually very good. But reconstruction will not restore normal sensation on your new breast or nipple. Recovery is usually faster when reconstruction is done after the mastectomy wound has healed. Having breast reconstruction surgery after breast cancer can improve your sense of well-being and quality of life. References Wilhelmi BJ, Phillips LG. Breast reconstruction. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 35. Reviewed By Review Date: 01/26/2011 Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Definition A mastectomy is surgery to remove the entire breast, including the skin, nipple, and areola. It is usually done to treat breast cancer. Alternative Names Breast removal surgery; Subcutaneous mastectomy; Total mastectomy; Simple mastectomy; Modified radical mastectomy Description You will be given general anesthesia (you will be asleep and pain-free). There are different types of mastectomy procedures. Which one your surgeon uses depends on the type of breast problem you have. The surgeon will make a cut in your breast: For a subcutaneous mastectomy, the surgeon removes the entire breast but leaves the nipple and areola (the colored circle around the nipple) in place. For a total or simple mastectomy, the surgeon cuts breast tissue free from the skin and muscle and removes it. The nipple and the areola are also removed. The surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread. In some rare breast cancers, a simple mastectomy is performed on both breasts. For a modified radical mastectomy, the surgeon removes the entire breast along with some of the lymph nodes underneath the arm. For a radical mastectomy, the surgeon removes the skin over the breast, all of the lymph nodes underneath the arm, and the chest muscles. This surgery is rarely done. The skin is closed with sutures (stitches). One or two small plastic drains or tubes are usually left in your chest to remove extra fluid from where the breast tissue used to be. If all the cancer tissue is removed, a plastic surgeon may be able to reconstruct the breast (with artificial implants or tissue from your own body) during the same operation. You may also choose to have reconstruction later. See also: Breast reconstruction - implants Breast reconstruction - natural tissue Mastectomy usually takes 2 to 3 hours. Why the Procedure Is Performed WOMAN DIAGNOSED WITH BREAST CANCER The most common reason for a mastectomy is breast cancer. If you are diagnosed with breast cancer, talk to your doctor about your choices: Lumpectomy is when only the breast cancer and tissue around the cancer are removed. This is also called breast conservation therapy or partial mastectomy. Part of your breast will be left. Mastectomy is when all breast tissue is removed. Mastectomy is a better choice if the area of cancer is too large to remove without deforming the breast. You and your doctor should consider: The size of your tumor, where in your breast it is located, whether you have more than one tumor in your breast, how much of your breast the cancer affects, and the size of your breasts Your age, family history, overall health, and whether you have reached menopause The choice of what is best for you can be difficult. Sometimes, it is hard to know whether lumpectomy or mastectomy is best. You and the health care providers who are treating your breast cancer will decide together what is best. WOMEN AT HIGH RISK FOR BREAST CANCER Women who have a very high risk of developing breast cancer may choose to have either a subcutaneous or total mastectomy to reduce your risk of breast cancer. This is called prophylactic mastectomy. You may have a higher risk of getting breast cancer if one or more close family relatives has had breast cancer, especially at an early age. Genetic tests (such as BRCA1 or BRCA2) may also show that you have a high risk. This surgery should be done only after very careful thought and discussion with your doctor, a genetic counselor, your family, and others. Mastectomy greatly reduces, but does not eliminate, the risk of breast cancer. Risks Risks for any surgery are: Blood clots in the legs that may travel to the lungs Blood loss Breathing problems Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney Heart attack or stroke during surgery Reactions to medications Scabbing, blistering, or skin loss along the edge of the surgical cut may occur. Risks when more invasive surgery, such as a radical mastectomy, is done are: Shoulder pain and stiffness. You may also feel pins and needles where the breast used to be and underneath the arm. Swelling of the arm (called lymphedema) on the same side as the breast that is removed. This swelling is not common, but it can be an ongoing problem. Damage to nerves that go to the muscles of the arm, back, and chest wall. Before the Procedure You may have many blood and imaging tests (such as CT scans, bone scans, and chest x-ray) after your doctor finds breast cancer. Your surgeon will want to know whether your cancer has spread to the lymph nodes, liver, lungs, bones, or somewhere else. Always tell your doctor or nurse if: You could be pregnant You are taking any drugs or herbs you bought without a prescription During the week before the surgery: Several days before your surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot. Ask your doctor which drugs you should still take on the day of the surgery. On the day of the surgery: Follow instructions from your doctor or nurse about eating or drinking before surgery. Take the drugs your doctor told you to take with a small sip of water. Your doctor or nurse will tell you when to arrive at the hospital. After the Procedure You may stay in the hospital for 1 to 3 days, depending on the type of surgery you had. If you have a simple mastectomy, you may go home on the same day. Most women go home after 1 to 2 days. You may stay longer if you have breast reconstruction. Many women go home with drains still in their chest. The doctor will remove them later during an office visit. A nurse will teach you how to look after the drain, or you can have a home care nurse help you. You may have pain around the site of your cut after surgery. The pain is moderate after the first day and then quickly goes away. You will be given pain medicines before you are released from the hospital. Fluid may collect in the area of your mastectomy after all the drains are removed. This is called a seroma. It usually goes away on its own, but it may need to be drained using a needle (aspiration). Outlook (Prognosis) Most women recover well after mastectomy. In addition to surgery, you may need other treatments for breast cancer. These treatments may include hormonal therapy, radiation therapy, and chemotherapy. All have their own side effects. Talk to your doctor. References Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Breast cancer. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. v2. 2010. Iglehart JD, Smith BL. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 34. Cuzick J, DeCensi A, Arun B, Brown PH, Catiglione M, Dunn B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011;12:496-503. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569-575. Reviewed By Review Date: 11/21/2011 Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.