General thoracic and cardiovascular surgery cases · 2023
Subcutaneous extension of perigraft seroma after thoracic aortic surgery - report of three cases.
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Doita Tsutomu, Yamasumi Taro, Nakamura Yuki, Kondoh Haruhiko
Аннотация
BACKGROUND: Subcutaneous extension of a perigraft seroma following thoracic aortic surgery is an infrequently encountered complication. For treatment, it is necessary to first exclude the possibility of perigraft fluid collection secondary to infection, a pseudoaneurysm, or impending rupture. However, it is difficult to diagnose collected fluid as indicative of a perigraft seroma, and there is also no standardized treatment for this condition.
CASE PRESENTATION: Three patients who had undergone graft replacement of a thoracic aorta with arch reconstruction were referred to our department for findings of a subcutaneous tumor. In each, computed tomography showed perigraft fluid accumulation in the posterior sternum. In one, a subcutaneous tumor had appeared in the center area of the median sternotomy, 4 months after the operation. It was considered that a wound infection was the likely cause; thus, negative pressure wound therapy was started after incisional drainage and debridement. However, a fever developed 14 days after debridement, resulting in mediastinitis, the latter of which was assumed to be caused by a retrograde infection of the incisional wound. In the other two cases, a subcutaneous tumor appeared in the center of the median area of the sternotomy at 3 and 4 months, respectively, after the operation. In both, the tumor was treated with continuous drainage by aspiration with negative pressure, and cultures of drainage samples were negative for infection. Neither patient had a fever during hospitalization, and fluid collection disappeared during follow-up. In one of the latter two cases, a subcutaneous tumor formed again 3 months after drainage, which was treated in the same manner and subsequently disappeared. Thereafter, there was no recurrence noted at the 3-year follow-up examination.
CONCLUSION: A perigraft seroma following thoracic aortic surgery, an infrequently encountered complication, has an appearance is similar to a subdermal tumor. Continuous aspiration drainage is a useful option for patients with no fever and negative for infection in drainage culture results.
CASE PRESENTATION: Three patients who had undergone graft replacement of a thoracic aorta with arch reconstruction were referred to our department for findings of a subcutaneous tumor. In each, computed tomography showed perigraft fluid accumulation in the posterior sternum. In one, a subcutaneous tumor had appeared in the center area of the median sternotomy, 4 months after the operation. It was considered that a wound infection was the likely cause; thus, negative pressure wound therapy was started after incisional drainage and debridement. However, a fever developed 14 days after debridement, resulting in mediastinitis, the latter of which was assumed to be caused by a retrograde infection of the incisional wound. In the other two cases, a subcutaneous tumor appeared in the center of the median area of the sternotomy at 3 and 4 months, respectively, after the operation. In both, the tumor was treated with continuous drainage by aspiration with negative pressure, and cultures of drainage samples were negative for infection. Neither patient had a fever during hospitalization, and fluid collection disappeared during follow-up. In one of the latter two cases, a subcutaneous tumor formed again 3 months after drainage, which was treated in the same manner and subsequently disappeared. Thereafter, there was no recurrence noted at the 3-year follow-up examination.
CONCLUSION: A perigraft seroma following thoracic aortic surgery, an infrequently encountered complication, has an appearance is similar to a subdermal tumor. Continuous aspiration drainage is a useful option for patients with no fever and negative for infection in drainage culture results.