Not too long ago, I got this great question from a member of my Facebook group dedicated to Manual Lymph Drainage and Lymphoedema therapists working with postop plastic surgery patients.

So, I though I should also record a video and write a quick blog about it.

In medical circles, we call this fluid 'serous' fluid. However, this fluid is a mix of lymph fluid and plasma caused by damage and leakage to both lymph vessels and blood capillaries. This is the same fluid that would be contained in a 'seroma', a common issue after abdominoplasty and liposuction.

However, 'proper' serous fluid is in fact different. 

We have three main caviities in our bodies: the pleura, the pericardium and the peritoneum. These three cavities contain vital organs and are surrounded by tissue that keeps everything within the cavity, enclosed. Serous fluid is produced by the serosa, and is a lubricating fluid that avoids friction of the tissues and membranes when there is movement.

We could say that a cavity is produced when tissues have been removed during liposuction. Or, when skin and muscles are separated during abdominoplasty and they haven't yet stuck together again. However, the fluid that is contained within that cavity is a mix of lymph and plasma and is quite normal after both of these procedures.

So, why are drains used? If the drains weren't in place, the fluid would continue to build up in the body, making the more susceptible to infection. And that fluid can have an effect on wound healing. You can imagine if fluid remains in a pocket, the space, or cavity will never close and the tissues won't adhere together again. That's why surgeons leave drains in until they are draining less than a certain amount, normall around the 25 - 50ml mark. The more extensive the surgery, the potential for larger amounts of fluid.

What about pushing that fluid out of the incisions?

For me, that's a BIG no no! Its the reason drains are put in place. A seroma should only be aspirated (drained using a cannula) by a medical professional trained in doing that job. Opening and reopening incisions to have fluid pushed out, is unethical, unprofessional and leaves the susceptible to infection - not to mention delayed healing of incisions.

The body is an amazing and brilliant piece of equipment. We have all the various systems to help us recover. As a postop therapists, you want to SUPPORT what the body does naturally. 

What are my tips?

• Encourage your patient to wear correct and well fitting compression for 24 hours for the first 6 weeks, dropping to 12 hours during the day for a further 6 weeks.
• Each time you see your patient at their M.L.D. session, reassess their progression; how the wound is healing and the quality of the tissues.
• Be mindful of not instigating any deeper techniques until they are well out of the inflammatory phase of wound healing. You don't want to contribute to any further inflammation and therefore swelling.
• Encourage patients to up their water intake and to have a good protein with every meal. Proteins are the building blocks of our bodies and important in recovery after surgery.
• Stress hormones have a detrimental effect on wound healing. So get your patient to do daily meditation or relaxation techniques.

If you would like more tips on how you can enhance your postop patient's recovery to optimise their healing, then send a message to [email protected]