Drainage of large or symptomatic seromas: Let the vacuum do the work

Seroma formation is frequently encountered in the postoperative period following a wide variety of procedures. The technique of drainage is therefore important in order to minimise the discomfort associated with the procedure and the risk of infection to both patient and healthcare workers. The usual technique, involving repeated aspiration and expulsion of seroma fluid via a needle, syringe and three-way tap, creates a temporary route for entry of microorganisms into the cavity, is cumbersome and often uncomfortable for both patient and operator. We routinely use a different technique involving a sterile vacuum drain and attached tubing, such as is inserted at operation (see Fig. 1). The tip of the tubing is cut so that a standard needle can be inserted into the end with an air-tight seal. The skin is cleaned and the needle is inserted into the seroma cavity. The vacuum is then released, allowing the seroma fluid to empty into the drain quickly and without further effort on behalf of the operator (Fig. 2). Once drained, the needle is removed and the drain clamped for disposal. An advantage of this technique is that it involves a closed sterile system. This should minimise the potential for the entry of microorganisms into the seroma cavity thus reducing infection risk for the patient. The drain is clamped at the end of the procedure. This reduces the risk of spillage and consequent exposure of healthcare workers to the seroma fluid. The technique is also quicker and more comfortable for both patient and operator, with the vast majority of seromas being drained using a single drain bottle.