title: Ultrasound-guided scraping of fibrous capsule plus bilayered negative pressure wound therapy for treatment of refractory postmastectomy seroma.
abstract: BACKGROUND
  Seroma is a frequent complication of breast cancer surgery. Treatment of prolonged or refractory seroma remains a clinical challenge. This study aimed to evaluate the efficacy of a novel approach for refractory seroma treatment; the method combines minimally invasive scraping for fibrous capsule removal and self-designed bilayered negative pressure wound therapy (b-NPWT) to achieve favorable wound healing.
  
  
  METHODS
  Twenty-four patients with refractory seroma received ultrasound-guided scraping of fibrous capsule around the refractory seroma, and then a bilayered NPWT system simultaneously allowing for fluid drainage and dynamic topical pressure was manually implemented immediately. The time of NPWT application and wound healing was recorded, and pathological examination was conducted for the removed fibrous tissues.
  
  
  RESULTS
  Removal of the fibrous capsule was securely achieved by minimally invasive scraping through a 1.5-cm incision guided with ultrasound scanning. All refractory seromas in the 24 patients healed uneventfully after an average application of NPWT for 7.2±3.3 days without recurrence during the 3-12 months of follow-up. Biopsy of the removed fibrous tissue demonstrated that single-layered endothelial cells stained with CD31, D2-40, and Ki-67 existed both on the surface of and inside the fibrous tissue.
  
  
  CONCLUSIONS
  The combination of fibrous capsule removal by ultrasound-guided scraping with successive bilayered NPWT therapy is effective and minimally invasive for promoting wound healing of refractory postmastectomy seroma.
authors.affiliation: Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Hongda
authors.initials: H
authors.lastname: Bi
authors.affiliation: Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Fang
authors.affiliation: Department of Ultrasound, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Jiang
authors.affiliation: Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China. Electronic address: xingxin57@163.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Xing
authors.affiliation: Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Haiying
authors.initials: H
authors.lastname: Dai
authors.affiliation: Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Xueying
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China. Electronic address: Lissot@163.com.
authors.forename: Junhui
authors.initials: J
authors.lastname: Li
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015409:Mastectomy, Radical; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D049291:Seroma / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014945:Wound Healing / Q000502:physiology
keywords: Drainage; Negative pressure wound therapy; Seroma; Wound healing