Incidence Of Seroma Formation Research Articles

Incisional Negative Pressure Wound Therapy Following Ventral Hernia Repair Reduces Wound Complications and Hernia Recurrence

BACKGROUND: Ventral hernia repair (VHR) is associated with postoperative wound complications and hernia recurrence, resulting in morbidity and significant healthcare costs. The purpose of this study was to identify whether postoperative wound complications and hernia recurrence are reduced by the application of negative pressure wound therapy to closed incisions (iNPWT) following VHR through systematic review and meta-analysis. METHODS: PubMed/MEDLINE, EMBASE, and SCOPUS databases were searched for studies published through December 2014. Publications that met the following criteria were included: (1) adult patients (>18 years) undergoing VHR; (2) comparison of iNPWT to conventional dressings ; and (3) documentation of wound complications and/or hernia recurrence. Methodological Index for Non-Randomized Studies guidelines were used to assess the methodological quality of included studies. Outcomes analyzed included surgical site infection (SSI), wound dehiscence, seroma, and hernia recurrence. Pooled odds ratios with confidence intervals were obtained through meta-analysis. RESULTS: Five retrospective cohort studies, totaling 477 patients undergoing VHR were included in the final analysis. The use of iNPWT decreased surgical site infection (Odds Ratio (OR)= 0.33; 95% Confidence Interval (CI), 0.20 - 0.55, p<0.0001; Figure 1), wound dehiscence (OR= 0.21; 95% CI, 0.08 - 0.55, p=0.001), and ventral hernia recurrence (OR= 0.24; 95% CI, 0.08 - 0.75, p=0.01; Figure 2). There is no statistically significant difference in the incidence of seroma formation (OR=0.59; 95% CI, 0.27 – 1.27, p=0.18).Figure 1: Figure 1.Figure 2: Figure 2.CONCLUSION: Current evidence suggests iNPWT decreases the incidence of wound complications and hernia recurrence when compared to conventional dressings.

Closure versus non-closure of fascial defects in laparoscopic ventral and incisional hernia repairs: a review of the literature.

The laparoscopic technique for repairing ventral and incisional hernias (VIH)is now well established. However, several issues related to laparoscopic VIH repair, such as the high recurrence rate for hernias with large fascial defects and in extremely obese patients, are yet to be resolved. Additional problems include seroma formation, mesh bulging/eventration, and non-restoration of the abdominal wall rigidity/function with only bridging of the hernial orifice using standard laparoscopic intraperitoneal onlay mesh repair (sIPOM). To solve these problems, laparoscopic fascial defect closure with IPOM reinforcement (IPOM-Plus) has been introduced in the past decade, and a few studies have reported satisfactory outcomes. Although detailed techniques for fascial defect closure and handling of the mesh have been published, standardized techniques are yet to be established. We reviewed the literature on IPOM-Plus in the PubMed database and identified 16 reports in which the recurrence rate, incidence of seroma formation, and incidence of mesh bulging were 0-7.7, 0-11.4, and 0%, respectively. Several comparison studies between sIPOM and IPOM-Plus seem to suggest that IPOM-Plus is associated with more favorable surgical outcomes; however, larger-scale studies are essential.

Postmastectomy seroma: how much is it affected by serum levels of IL-6 and CRP and how much is it reduced by intravenous hydrocortisone injection?

Background Seroma is extremely common after breast surgery, and this could be because of the inflammatory response during wound healing. Several factors such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been detected in the seroma fluid that support this assumption; therefore, inhibition of the inflammatory response by using hydrocortisone might decrease seroma formation. We aimed to evaluate the effect of adding hydrocortisone to the anesthetic regimen in the perioperative serum level of IL-6 and CRP and consequently in postmastectomy seroma formation. Patients and methods The study included female patients with primary operable breast cancer who were randomly allocated to two groups; each included 40 patients. Patients in group I received general anesthesia with hydrocortisone, and patients in group II received general anesthesia without hydrocortisone. Venous samples were collected for measuring IL-6 serum levels before surgery, 6 h after the end of the procedure, and 24 h after the procedure and for measuring CRP serum levels before surgery and 24 h after the procedure. All patients were followed up postoperatively for registration of the total drainage volume until drain removal, timing of drain removal, incidence of seroma formation, and management of seroma. Results Patients in group I had a lower total drainage volume ( P = 0.001), had the drain removed earlier ( P = 0.009), and had a lower incidence of postmastectomy seroma formation ( P = 0.005). Postoperative serum levels of IL-6 and CRP showed a significant decrease in group I compared with group II. Conclusion Postmastectomy seroma is likely a proinflammatory process and can be reduced by giving intravenous hydrocortisone on induction of anesthesia and 2 h later, which significantly decreases the inflammatory mediators (IL-6 and CRP) that significantly reduce the incidence of seroma.

Randomized Double-Blinded Prospective Trial of Fibrin Sealant Spray Versus Mechanical Stapling in Laparoscopic Total Extraperitoneal Hernioplasty

The aim of the current study was to compare the clinical outcomes of mesh fixation with fibrin sealant (FS) spray or mechanical stapling (MS) in laparoscopic total extraperitoneal hernioplasty (TEP). The most appropriate method of mesh fixation is uncertain. Between June 2007 and June 2011, consecutive patients with primary reducible unilateral inguinal hernia who underwent day-case laparoscopic TEP were recruited. Outcome parameters included the incidence of acute and chronic pain, recurrence rates, morbidity rates, analgesic requirements, quality-of-life (QOL) scores, and direct cost. During the study period, 130 patients were included in the study. Patients in the MS group had significantly worse pain scores on the day after operation (P = 0.006). Analgesic requirements were similar between the 2 groups (P = 0.558). At 6 months, no significant differences in the incidence of chronic pain were observed (at rest, after coughing or cycling). The incidence of seroma formation was similar between the 2 groups (P = 0.64), and no recurrences were observed at 1 year. No differences in the QOL scores were detected. The direct cost of the entire hospitalization in the FS group was less expensive (P < 0.001). FS and MS are both effective methods of providing mesh fixation. FS was associated with reduced acute pain but not chronic pain. The rates of seroma formation were similar. However, the use of FS for mesh fixation was less expensive. [corrected].

Fibrin sealant and lipoabdominoplasty in obese grade 1 and 2 patients.

BackgroundEver since lipoabdominoplasty was first developed to achieve better aesthetic outcomes and less morbidity, the rate of seroma formation, especially in obese patients, has disturbed plastic surgeons. The aim of this study was to evaluate the effect of fibrin sealant in the prevention of seroma formation after lipoabdominoplasty in obese patients.MethodsSixty patients with a body mass index (BMI) between 30 and 39.9 were assigned randomly to 1 of 2 groups (30 patients each). Group A underwent lipoabdominoplasty with fibrin glue, while group B underwent traditional lipoabdominoplasty; both had closed suction drainage applied to the abdomen. The patients' demographics and postoperative complications were recorded. Seroma was detected using abdominal ultrasound examinations at two postoperative periods: between postoperative days 10 and 12 and, between postoperative days 18 and 21.ResultsThe age range was 31 to 55 years (38.5±9.5 years) in group A and 25 to 58 years (37.8±9.1 years) in group B, while the mean BMI was 31.4 to 39.9 kg/m2 (32.6 kg/m2) in group A and 32.7 to 37.4 kg/m2 (31.5 kg/m2) in group B. In group A, the patients had a complication rate of 10% in group A versus 43% in group B (P<0.05). The incidence of seroma formation was 3% in the fibrin glue group but 37% in the lipoabdominoplasty-alone group (P<0.05).ConclusionsLipoabdominoplasty with the use of autologous fibrin sealant is a very effective method that significantly reduces the rate of postoperative seroma.

Analysis of selected factors influencing seroma formation in breast cancer patients undergoing mastectomy.

IntroductionThe aim of the work was to analyze the impact of selected factors on the incidence of seroma formation in breast cancer patients undergoing mastectomy.Material and methodsOne hundred and fifty breast cancer patients were prospectively enrolled in the study. All patients had mastectomy performed using the same operative technique with electrocoagulation. The amount of seroma formed after surgery and its duration were correlated with selected demographic, clinical and pathological parameters.ResultsThe cumulative total seroma volume collected by the end of treatment was higher and the overall time of seroma treatment was longer in patients over the age of 60 years (p = 0.001 and p = 0.001 respectively). Duration of seroma was significantly longer in obese patients (p = 0.036). The cumulative total seroma volume collected by the end of treatment was higher and the overall time of seroma treatment was longer in patients who had over 130 ml of lymph drained during the first 24 postoperative hours (p < 0.001 and p = 0.001 respectively). Additionally, longer duration of seroma was observed in patients with pathological stage I and II according to TNM-UICC (p = 0.042) and in patients with ≥ 1200 g weight resected of mammary gland (p = 0.05).ConclusionsAge and obesity are important prognostic factors influencing seroma formation in breast cancer patients undergoing mastectomy. The amount of lymph formed during first postoperative day may have predictive value in assessing cumulative total seroma volume collected during treatment and its overall duration.

Adjuncts in posterior lumbar spine fusion: comparison of complications and efficacy

The purpose of this study was to define the efficacy of recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) and Demineralized Bone Matrix (DBM) compared to autograft in posterior lumbar spine fusion by comparing complication rates. During a 7-year period (2003-2009), all patients undergoing posterior lumbar fusion were retrospectively evaluated within a large orthopedic surgery private practice. Patient demographics, comorbidities, number of levels, type of surgery, and types of bone void filler and osteobiologics were analyzed. Complications were defined as reoperation secondary to failed symptomatic fusion, hyper-reaction with fluid collections, bone overgrowth, and infections. 1,398 patients were evaluated with 41.1% males and 58.9% females. Mean age was 60years and BMI 30.6kg/m². Patients were subdivided in treatment groups: rhBMP-2, 947 (67.7%), DBM 306 (21.9%), and autograft 145 (10.4%). The overall infection rate was 2.1%. No significant differences were found between the three groups. The incidence of seroma formation was higher in the BMP group (3.2%) than in the DBM or autograft group (2.0 and 1.4%, respectively) but this was not significant (p=0.286 and p=0.245, respectively). 103 patients (7.4%) underwent redo surgery for clinically significant nonunion. We found significantly fewer nonunions (4.3%) in the rhBMP-2 group (p<0.001) compared to the DBM or autograft group (13.1 and 15.2%, respectively). ICBG is the gold standard. DBM leads to comparable fusion rates and does not increase infection or seroma formation. rhBMP-2 supplementation instead of ICBG or bone marrow aspirate results in higher fusion rates compared to autograft alone or autograft plus DBM.

Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia

I congratulate Bittner and colleagues for presenting this most valuable document on reviewed guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [1]. However, two closely related topics on the handling of a large direct sac and the risk of seroma formation need further explanation. I believe that part of their statements and recommendations lacks precision and therefore could be misleading. Page 2,793 of their article states: ‘‘level 2B: In large direct hernias, inversion and fixation of the extended fascia transversalis to Cooper’s ligament may reduce the frequency of occurrence of serohematoma.’’ The following page also has this recommendation: ‘‘Level 1B: The use of fibrin sealant (FS) for mesh fixation during bilateral TEP leads to a significant reduction of analgesic consumption but is associated with an increased incidence of postoperative seroma.’’ Although findings have shown that FS significantly reduces the incidence and volume of seroma formation after axillary dissection [2], the main reason for using it in TEP repair of inguinal hernia is that it offers an alternative to stapled fixation due to its adhesive property [3], thus avoiding tacker-related complications. These complications comprise not only potential vascular or nerve injury but also chronic pubalgia when the staple is placed in Cooper’s ligament [4]. Moreover, by offering the unique possibility of gluing the mesh inferiorly at the level of the triangles of doom and pain, FS reduces even further the risk of recurrence in expert hands [5]. In a personal series of[650 TEP inguinal hernia repairs using FS, only six early hernia recurrences were recorded, all in the initial phase of the study and most likely related to technical imperfection. Preliminary results of this approach have already been published elsewhere [6]. The authors mentioned the famous prospective study of Lau [7], which demonstrated a significantly higher incidence of seroma in the FS group than in the mechanical stapling group. I must clarify that the vast majority of his patients presented with a direct defect, and as clearly explained in his article, ‘‘FS was used to affix the mesh onto the Cooper’s ligament and pelvic floor, instead of applying it for sealing the potential space of the hernial cavity.’’ Yes, inversion and staple fixation of the lax fascia transversalis to Cooper’s ligament reduces the incidence of seroma formation, but this procedure can be favorably replaced by a much cheaper, safer, and more reliable alternative using a simple pre-tied suture (Endoloop Ligature of PDS II; Ethicon Endo-Surgery, Inc., CA), as initially presented at the 2010 Annual Scientific Congress of the Royal Australasian College of Surgeons in Perth [8]. The technique consists of inverting the extended fascia transversalis with a forceps while tying up an Endoloop at its base to leave a completely ‘‘flattened’’ fascia (Fig. 1). A prospective series of 250 patients had 76 repairs of direct inguinal hernias performed using the aforementioned technique, and only one patient (1.3 %) experienced a symptomatic groin seroma. In this case, the direct hernia defect was quite complex, multiloculated, and associated with an incisional hernia from a previous lower midline C. R. Berney (&) Department of Surgery, Bankstown-Lidcombe Hospital, University of New South Wales, 68 Eldridge Road, Bankstown, NSW 2200, Australia e-mail: berneycr@hotmail.com

Efficacy of Fibrin Glue on Seroma Formation after Breast Surgery

Background and Objectives. This study was designed to determine the effectiveness of fibrin glue plus conventional drain placement versus conventional drain placement in the prevention of seromas after breast procedures. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies, with controversial results. Design and Setting. A prospective, randomized, controlled study of subjects who were randomized into control and experimental groups was conducted. Methods. Collected data included age, surgeon, medical and surgical history, comorbidities, procedure performed, number of axillary nodes, number of positive axillary nodes collected, final pathologic diagnosis, cancer stage, hospital stay, postoperative day of drain removal, complications, incidence of seroma formation, interval to seroma resolution, and number of postoperative visits. Results. Analysis of 60 patients showed similarly matched groups. Seroma formation rate was 24.1% in the control group and 16.1% in the fibrin glue group. The rate of wound complications was similar. Conclusions. Although use of fibrin sealant resulted in a nonsignificant decrease in seroma formation rate compared with that of drain placement, the higher cost and cumbersome technique tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described.

Changes in Neuroforaminal Dimensions with Two-Level Axial Lumbar Interbody Fusion at L4-S1 with Graduated Distraction through the Implant

PURPOSE: The goal of this study was to evaluate the number of complications requiring reoperation for symptomatic failed fusion and hyper responsive compressive fluid collections. STUDY DESIGN/SETTING: Retrospective cohort study/one large orthopaedic surgery private practice associated with a tertiary referral spine center. PATIENT SAMPLE: 1158. OUTCOMEMEASURES: Complications related to rhBMP were defined as reoperation secondary to failed symptomatic fusion, hyper reaction resulting in compressive fluid collections, hyper formation of bone resulting in neural compression, and infections. METHODS: During a 7-year period of time (2002–2009), all patients undergoing lumbar posterolateral fusion utilizing of rhBMP-2 (INFUSE) were retrospectively evaluated within a large orthopaedic surgery private practice. Patient demographics, comorbidities, number of levels, and types of bone void filler (BVF) were analyzed. Complications related to rhBMP were defined as reoperation secondary to failed symptomatic fusion, hyper reaction resulting in compressive fluid collections, hyper formation of bone resulting in neural compression, and infections. RESULTS: 1158 consecutive patients were evaluated with 468 (40.4%) males and 690 (59.6%) females. Average age was 59.2 yo and BMI was 30.7 kg/m. Number of levels fused was: 1 (414, 35.8%), 2 (469, 40.5%), 3 (162, 14.0%), 4 (70, 6.0%), 5 (19, 1.6%), 6 (11, 0.9%), 7 (7, 0.6%), 8 (4, 0.3%), and 9 (2, 0.2%). Complications including add on stenosis requiring reoperation were 117/1158 (10.1%): Seroma with acute neural compression 32 (2.8%), excess bone formation with delayed neural compression 4 (0.3%), infection requiring debridement 26 (2.2%), and symptomatic nonunion requiring redo fusion and instrumentation 41 (3.5%). Nonunion was not related to smoking, number of levels fused, or age. There was an increased risk for nonunion in male patients and patients with previous BMP exposition. All nonunions were successfully treated with redo surgical instrumentation and rhBMP application. Seroma formation was not associated with interbody fusion, gender, BMI or comorbidities and was associated with acute exacerbation of radicular pain and transient neural involvement of varying degrees. The incidence of seroma formation was significantly higher in patients with higher doses of rhBMP-2 (p5.050) and especially in patients with more than 12 mg rhBMP-2 (c50.025). Bone reformation at the laminectomy and foraminotomy sites occurred in a delayed fashion associated with a solid union, progressive worsening of radicular pain, and were successfully treated with repeat neural decompression only. CONCLUSIONS: rhBMP-2 is a reliable adjunct for bone induction in posterolateral lumbar fusions. Complication rates using rhBMP-2 are low and do not exceed complication rates using iliac crest bone graft. A higher rate of seroma formation and infection occurs with increasing rhBMP-2 dose. Therefore, further studies concerning rhBMP-2 dosage are warranted. FDA DEVICE/DRUG STATUS: rhBMP-2: Investigational/Not approved.

Seroma Formation in Two Cohorts after Axillary Lymph Node Dissection in Breast Cancer Surgery: Does Timing of Drain Removal Matter?

The purpose of this study was to compare short-term versus long-term axillary drainage in women treated for lymph node positive breast cancer. A comparative cohort study on differences between short-term or long-term axillary drainage was performed. Primary outcome measures were seroma formation demanding aspiration and wound related complications. Secondary outcome measures were type of operation (modified radical mastectomy (MRM) or wide local excision with axillary lymph node dissection (ALND) or completing ALND after positive sentinel node), length of hospital stay, and visits to the emergency department and outpatient clinic. The short-term drainage group consisted of 37 patients, and the long-term drainage group of 40 patients. Short-term drainage was associated with a shorter hospital stay (1.7 versus 2.6 days, p = 0.01), but more visits to the emergency department (0.3 versus 0.1, p = 0.04) and outpatient clinic (3.6 versus 2.8, p = 0.03). Overall incidence of seroma formation was 40% and more frequently in the short-term drainage group (p = 0.01). The highest incidence of seroma and largest aspirated volumes were found in patients with short-term drainage and MRM. No difference in incidence of wound infection was found between both groups, and overall incidence of wound infection was 32%. Seroma formation itself was associated with a higher risk of wound infection (OR 4.39 95% CI 1.6-12.1). Short-term axillary drainage does not lead to an increase in wound-related problems, but is associated with a higher incidence of seroma. This seems especially the case in patients who underwent MRM. Therefore, we propose a differentiated policy: patients treated with MRM should be offered long-term axillary drainage, whereas patients treated with breast conserving therapy and ALND or completing ALND after a positive sentinel node should be offered short-term axillary drainage.

Comparison of Seroma Formation following Abdominoplasty with or without Liposuction

In light of the scarce literature published regarding seroma formation following abdominoplasty when performed with or without liposuction, the objective of this study was to determine whether abdominoplasty performed in conjunction with flank liposuction confers an increased risk for seroma formation compared with abdominoplasty alone. This was a retrospective cohort study of 200 patients who underwent abdominoplasty with or without liposuction from 2004 to 2007. Medical records were reviewed to collect data regarding patient demographics, length of drain use, operative technique, seroma formation, and other complications. Seroma formation was determined by physical examination 1 week after closed-suction drain removal. Logistic regression analysis was used to determine independent predictors of seroma formation. Results were considered significant for values of p < 0.05. One hundred twenty-five patients underwent abdominoplasty with flank liposuction and 75 patients underwent abdominoplasty alone. The incidence of seroma formation was 16.0 percent in the abdominoplasty-alone group and 31.2 percent in the abdominoplasty with liposuction group (p < 0.05). The mean age was 43.1 ± 10.2 years and the mean body mass index was 27.3 ± 5.4 kg/m2. Increasing body mass index (odds ratio, 1.1; 95 percent confidence interval, 1.02 to 1.17) and liposuction of the flanks (odds ratio, 3.3; 95 percent confidence interval, 1.37 to 7.97) were independent and significant predictors of seroma formation in abdominoplasty patients. Patients should be counseled regarding an increased risk of seroma formation following abdominoplasty when combined with liposuction of the flanks. In addition, patients who are overweight are at increased risk for developing a postoperative seroma compared with patients with normal body mass indices.

Postoperative Seroma Formation After Abdominoplasty with Placement of Continuous Infusion Local Anesthetic Pain Pump

The most common complication after abdominoplasty is seroma formation. The incidence of seroma formation in abdominal procedures as a whole, including abdominoplasty, panniculectomy and transverse rectus abdominis myocutaneous flap abdominal donor sites, ranges from 1% to 38%. A recent concern among surgeons is the possibility of a causal relationship between the use of continuous infusion devices such as local anesthetic pain pumps and the development of seromas. A case of postoperative, persistent, recurrent seroma formation after abdominoplasty with the use of continuous infusion local anesthetic pain pump is presented. After several attempts at aspiration and drain catheter placement, only open surgical excision of the seroma cavity was found to be definitively effective in treating the development of seroma.

External Ultrasound-Assisted Liposuction of the Abdomen: A Report of our Experience

Introduction: Ultrasound-assisted liposuction (UAL) is currently an accepted and commonly used method, although the incidence of complications is noteworthy. In 1997, Silberg introduced the concept of external ultrasound-assisted liposuction (XUAL) to facilitate the standard technique with an expected decreased incidence of complications when compared with UAL. This article reports our experience with XUAL of the abdomen at a single cosmetic surgery center over a 1-year period. Methods: Two groups of 15 patients each underwent abdominal liposuction. Group 1 received the tumescent technique, and Group 2 received external ultrasound treatment, again using the tumescent technique. Ultrasonic energy was applied to the entire abdominal area in a standard fashion using the Intellect Legend Combo 2-C ultrasound unit set to 1.5 watts/cm2 continuous pulse for 10 minutes immediately following infusion of the tumescent solution. Patients were evaluated postoperatively for adverse events. Adverse events were defined as excessive edema, ecchymosis, seroma greater than 50 cc, hematoma, infection, and wound breakdown. Results: No cases of adverse events occurred in any patient in the immediate postoperative period. However, at the first postoperative appointment, it was notable that 2 of 15 patients in group 1 (13%) had developed a significant (&gt;50 cc) lower abdominal seroma. Both patients were successfully treated with a single closed drainage procedure in the office via needle aspiration. In group 2 at the first postoperative visit, it was notable that 5 of the 15 patients (33%) presented with a significant (&gt;50 cc) lower abdominal seroma. All patients in group 2 were successfully treated with drainage of the fluid via needle aspiration or by opening the midline lower port and placing a passive drain (in several cases). An average of 2.5 drainage procedures was required for resolution of the seromas in group 2. Discussion: The incidence of seroma formation was clearly linked to higher body mass index (BMI) and total fat volume removed. Consistent variables included tumescent volume infused, amount of ultrasound energy delivered, and cannula size used during the tumescent infusion and aspiration procedure. In most patients, the flanks and low back were also sculpted with the liposuction technique; however, the abdomen was the only area treated preoperatively with ultrasound. It is notable that the only area to develop a seroma was the abdomen, which suggests that the ultrasound could be related to seroma formation. The cause of seroma formation remains unknown; however, the possibilities of septal breakdown, lymphatic and venous damage, and cavity formation are reasonable. Conclusion: The incidence of seroma formation may be increased with XUAL of the abdomen. Additional studies are needed to prove that the benefits of XUAL treatment provided preoperatively outweigh the risk for adverse events.

Lymphorrea incidences after modified radical mastectomy with auto cut versus spray mode electro coagulation

e11571 Background: Lymphorrea is one of the most common side effects subsequent to mastectomy. It is a predicting factor for seroma, which are usually painless; however, lymphorrea is also linked to wound infection, wound healing complications and lymphedema. Electrocautery is a significant risk factor for lymphorrea and seroma. Two electrocautery methods—auto cut and spray mode electro coagulation—were compared in this prospective randomized study. Methods: 68 patients with operable breast cancer intended for modified radical mastectomy with axillary lymph node dissection or sentinel node biopsy were randomized into two groups by their date of birth. The patients in the first group were operated by using high frequency coagulation with auto cut, the members of the second group in spray mode. All wounds were drained by two self-regulating suction drainages. The drainages were removed as soon as the drain volume decreased to less than 30 ml/24 hours. Results: The mean drain volume amounted to 276 ml (range 20- 1,200 ml) in the auto cut group and 546 ml (range 100 -1,600ml) in the spray mode group. This difference is highly significant (significance level &lt;0.01, t= -2.9987; p=0.003896). The incidence of seroma formation was 5% in the auto cut group and 23.5% in the spray mode group. Patients who were treated with spray mode electrocautery in average had to be hospitalized two days longer. Conclusions: The lower need for instrument changes makes the spray mode electro coagulation more comfortable for the surgeon. Nonetheless the conventional electrocautery should be preferred to operate radical mastectomy in order to decrease the morbidity risk for patients. No significant financial relationships to disclose.

Effect of quilting sutures on seroma formation post-abdominoplasty

Quilting sutures have been shown to be effective in reducing seroma in latissimus dorsi donor wounds. This technique has been adapted to the closure of abdominoplasty flaps. Seventy-four female patients aged 25 to 76 who underwent abdominoplasty over eight years were reviewed retrospectively. In the first 40 consecutive patients, no quilting sutures were used, in the subsequent 34 patients, abdominal closure was performed with quilting sutures. Primary outcome measures were the incidence of seroma, number of times aspirated and total volume aspirated. Secondary outcome measures were haematoma formation, return to theatre, necrosis, dehiscence, infection and late revision. Six of 34 (17.6%) patients who had quilting sutures placed developed clinically obvious seroma compared to ten of 40 (25%) not quilted. There was no significant difference in the number of times the seroma was aspirated or the volume aspirated between the two groups. Three patients in the ‘quilted’ group developed small postoperative haematomas, managed conservatively. All four patients who developed a haematoma in the 'non-quilted' group returned to theatre for evacuation. There is no statistically significant difference in the incidence of seroma formation after abdominoplasty with or without quilting sutures.

Continuous-Infusion Local Anesthetic Pain Pump Use and Seroma Formation with Abdominal Procedures: Is There a Correlation?

Seroma formation is the most commonly occurring complication in plastic surgery abdominal procedures. Continuous local anesthetic pain pump delivery systems are often used to decrease postoperative pain. An unreported concern with use of these devices in abdominal procedures is the effect of continuous fluid infiltration of the surgical site and a possible increase in the incidence of seroma formation. The authors performed a retrospective chart review to evaluate all patients (n = 159) who underwent abdominal procedures (abdominoplasty, panniculectomy, and transverse rectus abdominis myocutaneous flap harvest) over a 3-year period. Patient charts were evaluated for sex, age, body mass index, procedure performed, surgeon, operation length, pain pump use, postoperative seroma formation, and any complications. In cases with pain pump use, catheter placement location, anesthetic medication and strength, continuous-infusion rate, and duration of pain pump use were also reviewed. If a postoperative seroma formation was identified, treatment and outcomes were also recorded. The overall seroma formation rate was 11.3 percent (18 of 159 patients). Other complications occurred at a rate of 2.5 percent (four of 159). The incidence of seroma was 11.0 percent (11 of 100) in patients with pain pump use versus 11.9 percent (7 of 59) in those who did not use a pain pump. There was no statistically significant difference (p = 0.9) in the incidence of seroma formation between those who did and did not use a pain pump device. There was no correlation between increased rate of seroma formation and use of a continuous-infusion local anesthetic pain pump system in our patient population.

Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias

This study aimed to examine the recurrence rate and postoperative pain in total extraperitoneal repair (TEP) performed without fixation of the mesh and to compare the rates with those for repairs using fixation of mesh. A retrospective analysis was conducted over a 3-year period for 929 patients (1,753 hernias) who had undergone TEP. The recurrence rate, pain scores at 24 h and 1 week, hospital stay, days until resumption of normal activities, seroma formation, and urinary retention rates were noted. Of the 929 patients (1,753 hernias), the mesh was fixed (Fx) for 33 (61 hernias) and not fixed (NFx) for 896 (1,692 hernias). The follow-up period ranged from 6 to 40 months (mean, 17 months). The two groups did not differ significantly in terms of mean operating time, proportion of patients who had minimal or no pain (score, 1 or 2) 24 h after surgery, or proportion of patients who were totally pain free (score = 1) 1 week postoperatively. The proportions of patients reporting pain at the end of 1 month, the incidence of seroma formation and urinary retention, the hospital stay, and the days until resumption of normal activities were significantly greater in the Fx group than in the NFx group (p < 0.0001). Two patients (0.22%) in the NFx group had recurrence and one patient in the Fx group underwent conversion to open hernia repair. This study found TEP without mesh fixation to be safe and feasible with no increase in recurrence rates. The TEP procedure is associated with significantly less pain at 4 weeks, lower incidence of urinary retention and seroma formation, shorter hospital stay, and early resumption of normal activities.

Relationship between seroma formation after operation of breast cancer with comorbidity of internal diseases and patients' characteristics:a clinical study

Objective:To investigate the relationship between the incidence of postoperative seroma formation and the comorbidity of internal diseases.Methods:Clinical data from 130 patients who underwent breast surgery in the department of breast cancer in our hospital were collected and the seroma formation was observed prospectively.Univariate and multivariate analyses were used to analyze the risk factors related with seroma formation.The difference was compared between the seroma formation group and the control group.Results:Univariate analysis showed that the average of age(59.13 years old vs 51.37 years old,P=0.002)and body mass index(BMI)(25.33 vs 22.90,P=0.018) were both significantly higher in the seroma formation group.The incidence of hypertension was higher in the seroma group(30.4% vs 12.1%,P=0.027).Logistic regression analysis showed that age(OR=1.065,95%CI=1.012-1.116,P=0.016)and BMI(OR=1.193,95%CI=1.025-1.389,P=0.023) were independent risk factors for seroma formation.Conclusion:The incidence of postoperative seroma formation after breast surgery was related with age,BMI and comorbidity of internal diseases.The appropriate management during perioperative period may be beneficial for decreasing the incidence of seroma formation.

Risk of Seroma with Simultaneous Liposuction and Abdominoplasty and the Role of Progressive Tension Sutures

This study aimed to evaluate the true risk of seroma with simultaneous abdominoplasty and liposuction and to assess the role of progressive tension suture in preventing it. A retrospective chart review of 235 consecutive abdominoplasties performed by a single surgeon was conducted. Matarasso classification was used, and 146 patients with type 4 abdominoplasty were selected. These patients were divided into two groups. The 96 patients in group A had no progressive tension sutures. This group was further subdivided into subgroup A1 (43 patients), which had abdominoplasty alone, and subgroup A2 (53 patients), which had abdominoplasty with liposuction. The 50 patients in group B had progressive tension sutures. This group was further subdivided into subgroup B1 (26 patients), which had abdominoplasty alone, and subgroup B2 (24 patients), which had abdominoplasty with liposuction. The two groups were similar in terms of body mass index, age, and smoking status. The incidence of seroma formation was 26% (n = 25) in group A, as compared with 4% (n = 2) in group B (p = 0.001). Group B showed 0% seroma formation when abdominoplasty alone was performed, as compared with 7.7% when liposuction was performed at the same time (p = 0.08, no statistical difference). Also, no statistical difference was seen when similar subgroups were compared in group A (p = 0.87). The findings of this retrospective study show that the application of progressive tension sutures in abdominoplasty significantly reduces the incidence of seroma, and that simultaneous abdominoplasty with liposuction does not contribute to this complication.