Management of Postoperative Seroma: Recommendations Based on a 12-Year Retrospective Study

Abstract

Introduction: Seroma formation is a serious postoperative complication. Since the management algorithms available in the literature are scarce, we aimed to analyze our experience with postoperative seroma in order to identify indicators for revisional surgery and propose recommendations for management. Methods: This retrospective study included all patients with postoperative seroma treated in a tertiary university hospital from 2008 to 2020. Patients’ demographics, medical history, and seroma treatment details were recorded and analyzed. Results: Overall, 156 patients were included: 41% were initially treated through needle aspiration, with 61% eventually undergoing surgical treatment for postoperative seroma. Comorbidities, such as heart failure and coronary heart disease, were significantly associated with an increased need for revisional surgery (p < 0.05). Both a duration of >40 days of repeated needle aspirations and drain re-insertions were significantly correlated with an increased risk for revisional surgery (p < 0.05). Conclusion: Patients requiring seroma aspiration should be counseled on surgical treatment sooner rather than later, as prolonged aspiration time (over 40 days) greatly increases the risk of surgical revision. Moreover, the reinsertion of a drain should only be used as a temporizing measure, at most, and patients requiring a drain to control the size of the seroma should promptly be scheduled for a surgical revision.

A Case Series and Literature Review: Management Strategies for Radiation-Induced Ulcers of the Chest

“…Management may include serial aspirations, sclerosing agents in the seroma cavity, surgical marsupialization or excision of the seroma capsule, and drainage. 23 Varying degrees of radiation-induced tissue injury, ranging from radiation dermatitis to osteoradionecrosis, require different therapeutic approaches. Prevention is the ideal initial approach; however, the incidence of radiation-induced ulcers remains a complex issue.…”

Bioglass/ceria nanoparticle hybrids for the treatment of seroma: a comparative long-term study in rats

“…The most common surgeries where seroma formation can be expected postoperatively are abdominoplasty ( Rousseau et al, 2011 ; Marsh et al, 2015 ; Anker et al, 2021 ), mastectomy with or without axillary dissection ( Kumar et al, 1995 ) and the donor site after harvesting the latissimus dorsi muscle for reconstructive purposes ( Llewellyn-Bennett et al, 2012 ). Seroma is associated with a multitude of adverse effects, such as, increased risk of infection, wound dehiscence, prolonged drainage, recurrent aspirations, multiple hospital admissions, recurrent surgeries, and frequent follow-ups which makes the current therapeutic management of seroma troublesome ( Kuroi et al, 2005 ; Anker et al, 2021 ; Papanikolaou et al, 2022 ). Treatment options in seroma management include various non-surgical and surgical options, from application of sclerosing agents into the seroma, serial aspirations, prolonged drainage, to surgical marsupialization or debridement of the seroma capsule ( Beidas and Gusenoff, 2019 ; Papanikolaou et al, 2022 ).…”

“…Seroma is associated with a multitude of adverse effects, such as, increased risk of infection, wound dehiscence, prolonged drainage, recurrent aspirations, multiple hospital admissions, recurrent surgeries, and frequent follow-ups which makes the current therapeutic management of seroma troublesome ( Kuroi et al, 2005 ; Anker et al, 2021 ; Papanikolaou et al, 2022 ). Treatment options in seroma management include various non-surgical and surgical options, from application of sclerosing agents into the seroma, serial aspirations, prolonged drainage, to surgical marsupialization or debridement of the seroma capsule ( Beidas and Gusenoff, 2019 ; Papanikolaou et al, 2022 ). There have also been studies looking at prevention strategies to avoid the formation of seroma, such as drainage placement during the initial surgery ( Unalp and Onal, 2007 ; Papanikolaou et al, 2022 ; Shipkov and Uchikov, 2023 ), compression garments ( Chen et al, 1998 ; Brown et al, 2023 ; Shipkov and Uchikov, 2023 ), and even treatment with fibrin glue ( Llewellyn-Bennett et al, 2012 ; Pollock and Pollock, 2012 ; Azoury et al, 2015 ).…”

“…Treatment options in seroma management include various non-surgical and surgical options, from application of sclerosing agents into the seroma, serial aspirations, prolonged drainage, to surgical marsupialization or debridement of the seroma capsule ( Beidas and Gusenoff, 2019 ; Papanikolaou et al, 2022 ). There have also been studies looking at prevention strategies to avoid the formation of seroma, such as drainage placement during the initial surgery ( Unalp and Onal, 2007 ; Papanikolaou et al, 2022 ; Shipkov and Uchikov, 2023 ), compression garments ( Chen et al, 1998 ; Brown et al, 2023 ; Shipkov and Uchikov, 2023 ), and even treatment with fibrin glue ( Llewellyn-Bennett et al, 2012 ; Pollock and Pollock, 2012 ; Azoury et al, 2015 ). But yet standard of care protocols and management recommendations in a clinical setting are missing.…”

“…For example, supplementation with fibrin sealant has previously shown efficacy in a rat model ( Kulber et al, 1997 ), but it failed to show any benefit for minimizing seromas in a randomized controlled trial in the clinical setting ( Llewellyn-Bennett et al, 2012 ). Commonly, fibrin sealant is used in combination with tensile-reducing quilting sutures ( Sajid et al, 2011 ; Papanikolaou et al, 2022 ), but its limitations are the expenses of fibrin glue and the added surgical time matter, on the other hand ( Pollock and Pollock, 2012 ; Azoury et al, 2015 ). Another approach was based on the idea of preventing fibrinolysis with the consequence of degradation of already formed fibrin complexes, using tranexamic acid, an antifibrinolytic agent ( Oertli et al, 1994 ).…”