Persistent Inguinal Seroma Managed With Sprinkling of Talcum Powder

A Case Report

Javier Lopez-Monclus; Miguel A Garcia-Ureña; Luis A Blázquez; Daniel A Melero; Carmen Jiménez-Ceinos

Disclosures

J Med Case Reports. 2012;6(391) 

In This Article

Discussion

Seroma is a frequent complication after open repair of inguinal hernia, with a variable incidence reported by different groups due to it being underreported. Most seromas are asymptomatic and inconspicuous on inspection, and diagnosis is based on the clinical finding of a palpable fluid collection in the subcutaneous tissue.

Most seromas resolve spontaneously without any intervention. Park et al.[5] suggest that a seroma should be considered a complication only if it persisted for more than six weeks, presents continuous growth, or becomes symptomatic. If an underlying complication is suspected, such as infection or recurrence, then groin ultrasonography is the initial technique to confirm the nature of the swelling.[6]

Despite its benign appearance, seroma persistence can become a major problem for patients, impairing their quality of life during the weeks until its complete resolution.

Nowadays there is no consensus on the management of symptomatic seroma: it varies from percutaneous aspiration to surgical drainage or the instillation of sclerosing substances.

Percutaneous seroma aspiration is the most widely used technique for symptomatic seroma management. This technique of repeated needle aspiration and mild application of external pressure was first described in 1971,[7] but it is associated with a higher risk of seroma infection and a high recurrence rate.[8,9]

A more aggressive 3-trocar laparoscopic approach was described by Lehr and Schuricht[10] for treatment of persistent seromas after laparoscopic postincisional hernia repair. The technique described consists of evacuating both the serous fluid and the fibrinous debris followed by argon beam scarification of the seroma cavity lining. When seroma develops a thick surrounding capsule then it is considered a cystic seroma, and capsule removal might be the only curative option.[11]

From our point of view, a persistent seroma could be extrapolated to the clinical scenario of a chronic pleural effusion: a cavity with a persisting exudative surface. Talcum powder was first used in 1935 to produce pleurodesis before carrying out a lobectomy. After this report, intrapleural talcum powder application has been demonstrated to be one of the most effective, simplest, and with the highest cost-benefit ratio, procedures for the treatment of recurrent pleural effusions. Talcum powder induces a strong fibrotic reaction in the pleural cavity due to the activation of polymorphonuclear neutrophils, interleukin 8 and fibroblast growth factor.[12] Complications related to talcum powder pleurodesis are not frequent; the most common adverse effect is pyrexia secondary to the inflammatory process, and major systemic complications are exceptional.

In our patient, talcum powder administration was easy and safe, with no complications and an outstanding result. The only complaint was a mild burning sensation in the groin area, and a local inflammatory response manifested as local redness that lasted 48 hours. Neither local nor systemic side effects have been described in the publications describing the use of talcum powder in abdominal wall surgery.

Nevertheless, the idea of using talcum powder as a treatment of symptomatic seromas it is not original to our group. In 1993, Coons et al.[13] published an experimental study in dogs comparing seroma formation in two groups after dissecting the latissimus dorsi muscle and applying talcum powder in one of them. They concluded that talc poudrage was clearly effective at minimizing seroma formation after the disection of musculocutaneous flaps. This article would open the unexplored field of talc poudrage to prevent seroma formation after inguinal or incisional hernioplasty.

In 2006, Saeb-Parsy et al.[14] described the application of talcum powder in an 8-month recurrent chronic seroma after breast surgery. They sprinkled four g of talcum powder inside the seroma cavity, and 10 weeks after its application the wound was completely healed.

Most recently, Klima et al.[15] have published the use of prophylactic subcutaneous talcum powder in incisional hernia repair, with a significant reduction of seroma formation and less wound infections and hernia recurrence. This report would support the safety of talc poudrage in abdominal wall surgery.

In fact, in 1983 an isolated article preconized the use of tetracycline sclerotherapy (the other most extended pleurodesis technique) for the treatment of persistent seromas; the physical basis of this variant would be the same as in the talcum powder technique described.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....