Seroma In Group Research Articles

The Effect of Drains and Compressive Garments Versus Progressive Tensioning Sutures on Seroma Formation in Abdominoplasty.

Seroma is a common problem following abdominoplasty surgery. Both compressive garments with drains and progressive tension sutures have their advocates to minimise seroma formation. This is a retrospective study in which patients underwent an identical surgical procedure, except for use of drains and garments in comparison to progressive tension sutures between 2005 and 2020. Two hundred thirty-two patients were included in the study 61 in the drains and garment group (DG group), and 171 with progressive tension sutures (PTS group) alone. There was a lower incidence of seroma formation in the PTS group (X2(1, N = 232) = 6.35, P = .012). The weight of tissue excised in the PTS group was greater than the DG group (P < .001). There was there a significantly higher tissue excision weights for patients who developed a seroma, compared with those who did not (P=.02). Patients, who developed a seroma in the PTS group, had significantly greater excision weights than the DG group. Liposuction did not change the incidence of seroma in each group (X2(4, N = 232) = 6.701, P = .08n/s). This study demonstrates the effectiveness of progressive tension sutures in reducing the incidence of seroma formation following abdominoplasty, particularly when large excision weights are involved. The addition of small volume liposuction distant to the abdominal flap does not increase the incidence of seroma formation.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Impact of Device Innovation on Clinical Outcomes in Expander-based Breast Reconstruction

Background:Staged expander-based breast reconstruction represents the most common reconstructive modality in the United States. The introduction of a novel tissue expander with an integrated drain (Sientra AlloX2) holds promise to further improve clinical outcomes.Methods:Patients who underwent immediate expander-based pre-pectoral breast reconstruction were identified. Two cohorts were created, that is, patients who underwent placement of a conventional tissue expander [133MX (Allergan)] (Group 1) versus AlloX2 (Sientra) (Group 2). The study endpoint was successful completion of expansion with the objective being to investigate differences in outcome following expander placement.Results:Fifty-eight patients underwent 99 breast reconstructions [Group 1: N = 24 (40 breasts) versus Group 2: N = 34 (59 breast)]. No differences were noted for age (P = 0.586), BMI (P = 0.109), history of radiation (P = 0.377), adjuvant radiotherapy (P = 1.00), and overall complication rate (P = 0.141). A significantly longer time to drain removal was noted in Group 1 (P < 0.001). All patients with postoperative infection in Group 1 required surgical treatment versus successful washout of the peri-prosthetic space via the AlloX2 drain port in 3 of 5 patients in Group 2 (P = 0.196). Furthermore, both cases of seroma in Group 1 required image-guided drainage versus in-office drainage via the AlloX2 drain port in 1 patient in Group 2 (P =0.333).Conclusion:The unique feature of the AlloX2 provides surgeons easy access to the peri-prosthetic space without altering any of the other characteristics of a tissue expander. This resulted in a reduced time to drain removal and facilitated management of postoperative seroma and infection.

Prospective comparison of indwelling cannulas drain and needle aspiration for symptomatic seroma after mastectomy in breast cancer patients

AimsPostoperative seroma is the most frequent sequelae after mastectomy and axillary surgery with no optimal regimens for seroma resolution recommended in routine clinical. Indwelling cannulas with needle and catheter have been widely used in long-term medication therapies, but evidence of indwelling cannulas in seroma management after mastectomy is lacking. The purpose of this study is to evaluate the feasibility of indwelling cannulas in seroma management after mastectomy.MethodsPatients who underwent modified radical mastectomy (MRM) and developed symptomatic seroma after removal of the drains between August 2017 and December 2018, were randomized into two groups either indwelling cannulas drain of seroma (Group A) or needle aspiration of seroma (Group B). We prospectively compared the number of visits for seroma, the time from removal of the drain to the final seroma resolution and the cost between the methods.ResultsA total of 860 patients underwent MRM between August 2017 and December 2018, among which 86 patients who developed symptomatic seroma after removal of the drains, were randomized into two groups either Group A or Group B. The number of visits for seroma in Group A was 2.35 ± 0.69 times, which was less than those in Group B (4.86 ± 1.06 times). Similarly, the time of drain removal to final seroma resolution in Group A was 4.65 ± 0.78 days, which was shorter than 7.09 ± 1.54 in Group B. In Group A, the total mean cost per patient (25.81 ± 7.71 RMB) was less than the total mean cost per patient (49.30 ± 9.85 RMB) in Group B. Cost savings were noted with using indwelling cannulas in seroma management.ConclusionIt is feasible to drain indwelling cannulas drain for postmastectomy seroma, with less visits for patients, rapid seroma resolution and less cost. Indwelling cannulas can be an efficient, cost effective solution to treat symptomatic seroma after breast surgery.

English

BACKGROUND: Seroma formation and its sequelae including infection, flap necrosis, delayed wound healing and patient discomfort form one of most commonly encountered complication following mastectomy and axillary dissection. Mechanical closure of dead space by flap fixation is a simple surgical procedure that eliminates dead space after mastectomy, by decreasing the movement of flap over chest wall and thereby reducing the exudate. OBJECTIVE: The objective of this study is to evaluate the effect of mechanical closure of dead space after mastectomy in prevention of seroma formation. METHOD: A total of 80 patients of Carcinoma Breast who underwent Modified Radical Mastectomy in Department of general surgery, Government Rajaji Hospital, Madurai during the period from March 2016 to August 2016, were included in this prospective study, and randomized into two groups based on in-patient number. 42 patients with odd IP no in conventional simple wound closure (Group A) and 38 patients with even IP no in Flap fixation (Group B). Patients were evaluated for day 1 drain volume, total drain volume, drain removal day, seroma, and wound complications. RESULT: Of the 80 women, 42 women with mean age 48±8 years belongs to group A and 38 women with mean age 46±7 years belongs to group B. Average size of the tumor at presentation was 3.4cm. 36 (45%) women presented with stage IIA disease and 44 (55%) with stage IIB disease. Drain volume in first post-operative day varied from 100 to 200ml with average of 170ml in group A and 163ml in group B. There was no statistically significant difference in the drain volume in first post-operative day (p > 0.05). The average total drain volume in the post-operative period in group A was 1426ml and 932ml in group B. p value was found to be significant (< 0.001). The average day of drain removal in group A was 13 days and 8 days in group B. p value was found to be significant (< 0.001). 8 patients developed seroma in Group A Vs none in group B. p value was found to be significant (> 0.05). One patient developed wound complication (cellulitis) Vs none in group B. There was no statistically significant difference in the incidence of wound complications in both groups. CONCLUSION: The present prospective study demonstrated that the mechanical obliteration of dead space by flap fixation significantly decreases the incidence of seroma formation. So when performing modified radical mastectomy, the flap-fixation technique is a valuable technique for reducing seroma formation allowing early drain removal and increased patient satisfaction.

Karydakis Flap With Compressing Tie-over Interrupted Sutures Without Drain versus Standard Karydakis for Treatment of Sacrococcygeal Pilonidal Sinus Disease.

Sacroccygeal pilonidal sinus disease is a worldwide health problem, affecting young adults, mainly males, with a tendency for recurrence. Various modalities have been used for treating this condition. The Karydakis procedure is one of most commonly used asymmetric flaps for treating this condition. The study aimed to evaluate the Karydakis procedure with tie-over compressing sutures instead of the routine use of a drain in the treatment pilonidal sinus. This prospective randomized controlled clinical study was conducted between January 2010 and January 2015. The study was conducted at Minia University Hospital. The study included 154 patients. Patients were randomly assigned into 2 equal groups. The patients in group 1 were operated on by the standard Karydakis procedure, and the patients in group 2 were operated on by the Karydakis procedure with tie-over compressing sutures without a drain. The primary outcomes measured were the incidence of seroma formation, wound complications, length of hospital stay, off-work time, and recurrence rate. All patients were discharged on the same day of surgery in group 2 compared with a mean hospital stay of 4.9 ± 2.4 days in group 1. No patients developed seroma in group 2 compared with 7.8% in group 1. In group 2, 1.3% of patients developed wound infection compared with 9.1% in group 1. The average time for return to work in group 2 was 10.2 ± 1.4 days compared with 12.6 ± 4 days in group 1. No recurrences were noted in group 2 compared with 2.6% in group 1. The feedback about postoperative pain and patient satisfaction about the scar were not investigated. The extent of the disease in both groups was not investigated. The duration of follow-up too short to accurately weight recurrence rate. Karydakis flap with tie-over compressing interrupted sutures without a drain is safe, 1-day surgery with the lowest complications rate.

Haemostasis in Thyroid Surgery: Collagen-Fibrinogen-Thrombin Patch versus Cellulose Gauze-Our Experience.

Purpose. Postoperative hemorrhage is fortunately uncommon but potentially life-threatening complication of thyroid surgery that increases the postoperative morbidity and the hospital stay. In this study we compare the efficacy of collagen patch coated with human fibrinogen and human thrombin (CFTP) (group C) and oxidized regenerated cellulose gauze (group B) versus traditional hemostatic procedures (group A) in thyroid surgery. Methods. From January 2011 to December 2013, 226 were eligible for our prospective, nonrandomized, comparative study. Patients requiring a video-assisted thyroidectomy without drain, “near total,” or hemithyroidectomy were excluded. Other exclusion criteria were a diagnosis of malignancy, substernal goiter, disorders of hemostasis or coagulation, and Graves or hyperfunctioning thyroid diseases. Outcomes included duration of operation, drainage volume, and postoperative complications. Results. Our results show a significant reduction in drainage volume in group C in comparison with the other two groups. In group C there was no bleeding but the limited numbers do not make this result significant. There were no differences in terms of other complications, except for the incidence of seroma in group B. Conclusion. The use of CFTP reduces the drainage volume, potentially the bleeding complications, and the hospital stay. These findings confirm the efficacy of CFTP, encouraging its use in thyroid surgery.

Abstract P2-13-28: Flap fixation reduces seroma in patients undergoing mastectomy: A significant implication for clinical practice

Abstract Background Seroma formation is a common complication following mastectomy for invasive breast cancer. Seroma formation can cause problems in wound healing and infection, thus leading to seroma aspirations and repeated visits to the out-patient clinic. The key to reducing seroma formations seems to partly lie in the obliteration of dead space. However, the techniques used to achieve this goal are subjects of much controversy and debate. Mastectomy flap fixation (FF) is achieved by reducing dead space volume using interrupted subcutaneous sutures. We hypothesized that obliteration of the dead space following mastectomy would significantly reduce seroma formation, resulting in fewer outpatient visits and seroma aspirations. This study, aiming to reduce seroma formation after mastectomy, is a retrospective study that compared conventional mastectomy with mastectomy and flap fixation. Methods All patients undergoing mastectomy due to invasive breast cancer were eligible for inclusion. From May 2012 – March 2013 all patients undergoing mastectomy in 2 hospitals were treated using flap fixation. The skin flaps were sutured on to the pectoral muscle using polyfilament absorbable sutures. The data was retrospectively analyzed and compared to a historical control group (HC) that was not treated using flap fixation (May 2011 – March 2012). In the HC group, only the skin was sutured. Closed suction drainage was applied to all patients in both groups. Results 180 patients were included; 92 in the FF group and 88 in the HC group. There were no significant differences in patient demographics. 36% of patients developed seroma in the group that underwent flap fixation; 59% of patients developed seroma in the historical control group (P=0.002). Seroma aspiration was performed in 15% of patients in the flap fixation group as opposed to 43% of patients in the control group (P&amp;lt;0.001). Multivariate analysis showed that the effect of flap fixation varied with the extent of surgery: whereas flap fixation reduced seroma formation in patients undergoing simple mastectomy or mastectomy with sentinel node recovery, FF did not reduce seroma formation in patients undergoing mastectomy with axillary lymph node dissection (i.e. modified radical mastectomy; P=0.04 for interaction. Effects of flap fixation on seroma formation stratified by operation type Historical ControlFlap fixationPMastectomy8/14 (57%)1/6 (17%)0.16Mastectomy and SN26/42 (62%)13/52 (25%)&amp;lt;0.001Modified Radical Mastectomy18/32 (56%)19/34 (56%)0.98 In contrast, flap fixation was associated with fewer seroma aspirations in all types of surgery (P=0.80 for interaction). Effects of flap fixation on seroma aspiration stratified by operation type Historical ControlFlap fixationPMastectomy6/14 (43%)1/6 (17%)0.35Mastectomy and SN19/42 (45%)7/52 (14%)0.001Modified Radical Mastectomy13/32 (41%)6/34 (18%)0.04 Conclusion Patients undergoing mastectomy flap fixation displayed a significant reduction in seroma formation and fewer patients were subjected to seroma aspiration. Patients undergoing flap fixation required fewer seroma aspirations. Flap fixation is an effective surgical technique in reducing dead space and therefore seroma formation in patients undergoing mastectomy for IBC. Citation Format: James Van Bastelaar, Arianne Beckers, Maarten Snoeijs, Yvonne Vissers. Flap fixation reduces seroma in patients undergoing mastectomy: A significant implication for clinical practice [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-28.

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.

Total extraperitoneal (TEP) mesh repair of inguinal hernia in the developing world: comparison of low-cost indigenous balloon dissection versus direct telescopic dissection: a prospective randomized controlled study

Creation of extraperitoneal space during TEP repair requires an expensive commercially available balloon. Fifty-six patients suffering from uncomplicated primary unilateral or bilateral groin hernia were randomized into two groups; group 1--indigenous balloon dissection and group 2--direct telescopic dissection. There were 55 males and 1 female, with an average age of 49 years; 50% of the inguinal hernias were bilateral. Creation of extraperitoneal space was considered as satisfactory in majority of patients (94.6%) with satisfactory anatomical delineation. Peritoneal breach was noticed during dissection in 36 (64.3%) patients. There was one (3.8%) conversion of TEP to TAPP in group 2. Distance between pubic symphysis to umbilicus was an important factor, which affected the easiness of dissection. In patients with this distance <or=14 cm lateral placement of ports was considered for easy use of graspers. The incidence of scrotal edema was significantly higher in group 2 as compared with group 1 (p < 0.01). Patients with indirect inguinal hernias in group 2 presented with a greater number of scrotal edema. Pain score on VAS at 6 h after surgery was significantly higher in group 2 (p < 0.021). Patients with age <65 years, bilateral hernias, and indirect hernias had a correlation with higher pain score at 6 h. Of the patients, 17.9% developed seroma in group 1 versus 64.3% in group 2 (p < 0.001). Anatomical delineation of inguinal area and dissection in the extraperitoneal space in TEP repair was equally satisfactory with both low-cost indigenous balloon (group 1) and telescopic dissection (group 2). Balloon dissection was associated with significantly reduced postoperative pain at 6 h, scrotal edema, and seroma formation. However at 3 months follow-up balloon dissection did not offer significant advantage over direct telescopic dissection in the overall long-term outcome of TEP repairs. If balloon dissection is considered useful for the beginner, low-cost indigenous balloon may be used to avoid higher cost of commercially available balloon dissector with added early advantages.