A seroma represents an accumulation of a sterile ultrafiltrate of serum surrounded by a fibrous tissue pseudocapsule.
Complications:
(1) infection
(2) erosion through the skin
(3) dehiscence
(4) graft loss
(5) thrombosis
(6) loss of available area for graft puncture
Risk factors for formation of a seroma:
(1) placement of the graft in the upper arm
(2) wetting of the graft with chemicals (alcohol, povidone-iodine), serum, blood or liquefied fat that hinder the deposition of protein and fibrin that seal the graft
(3) failure to use a protective sheath over the graft
(4) extensive manipulation of the graft
(5) angulation or bending of the graft
(6) anemia
(7) reduced oncotic pressure secondary to hypoproteinemia related to malnutrition
(8) high blood flow rates through the graft
(9) removing the arterial clamps before the venous clamps after performing the anastomosis
If uncontrolled weeping is seen during the placement of graft then the weeping segment should be removed.
Recurrence of the seroma is high if the fluid is simply evacuated.
The graft can be salvaged by aggressive management. This should include
(1) removal of the seroma capsule
(2) bypassing the affected segment
