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Strategies for Postoperative Seroma Prevention: A Systematic Review

Janis, Jeffrey E. M.D.; Khansa, Lara Ph.D.; Khansa, Ibrahim M.D.

Plastic and Reconstructive Surgery: July 2016 - Volume 138 - Issue 1 - p 240-252
doi: 10.1097/PRS.0000000000002245
Reconstructive: Trunk: Original Articles
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Discussion

Background: There is conflicting evidence on the effectiveness of the various strategies to prevent postoperative seroma. Many high-quality studies have been performed to evaluate those strategies, but the numbers of patients included in those studies have been small. The authors’ goal was to perform a systematic review of all Level I and II studies on the prevention of postoperative seroma.

Methods: A PubMed search was performed of all Level I and II studies that evaluated strategies for the prevention of postoperative seroma. Only English-language comparative studies on humans, defining seroma as a postoperative serous fluid collection detectable on physical examination, were included. Data from all the studies were compiled, and a systematic review was performed to evaluate the effectiveness of each strategy.

Results: Seventy-five studies comprising 7173 patients were included. Effective strategies for seroma prevention included the use of closed-suction drains; keeping the drains until their output volume was minimal; maintaining a high pressure gradient in the drains; using sharp or ultrasonic dissection rather than cautery; dissecting the abdomen in a place superficial to the Scarpa fascia; ligating blood vessels with sutures or clips; using quilting or progressive tension sutures; using fibrin, thrombin, or talc; and immobilizing the surgical site postoperatively. Surgical-site compression did not prevent seroma accumulation. The use of sclerosants at the initial operation actually increased the risk of seroma.

Conclusions: Seroma is a common and frustrating complication in plastic surgery. This study demonstrates that simple strategies can be used to lower the risk of seroma.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Columbus, Ohio; and Blacksburg, Va.

From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center; and the Department of Business Information Technology, Pamplin College of Business, Virginia Tech.

Received for publication October 8, 2015; accepted February 10, 2016.

Disclosure:Dr. Janis is a consultant for Acelity, has received a prior honorarium from Pacira and Bard, and receives royalties from Quality Medical Publishing/CRC Press. The remaining authors have no relevant financial disclosures.

Jeffrey E. Janis, M.D., Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, Ohio 43212, jeffrey.janis@osumc.edu

Copyright © 2016 by the American Society of Plastic Surgeons