TY - JOUR
T1 - Strategies for postoperative seroma prevention
T2 - A systematic review
AU - Janis, Jeffrey E.
AU - Khansa, Lara
AU - Khansa, Ibrahim
N1 - Publisher Copyright:
© 2016 by the American Society of Plastic Surgeons.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - 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.
AB - 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.
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U2 - 10.1097/PRS.0000000000002245
DO - 10.1097/PRS.0000000000002245
M3 - Review article
C2 - 27348657
AN - SCOPUS:84976448840
SN - 0032-1052
VL - 138
SP - 240
EP - 252
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 1
ER -