title: Strategies for Postoperative Seroma Prevention: A Systematic Review.
abstract: 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.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Columbus, Ohio; and Blacksburg, Va.|From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center; and the Department of Business Information Technology, Pamplin College of Business, Virginia Tech.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Janis
authors.affiliation: Columbus, Ohio; and Blacksburg, Va.|From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center; and the Department of Business Information Technology, Pamplin College of Business, Virginia Tech.
authors.forename: Lara
authors.initials: L
authors.lastname: Khansa
authors.affiliation: Columbus, Ohio; and Blacksburg, Va.|From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center; and the Department of Business Information Technology, Pamplin College of Business, Virginia Tech.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khansa
mesh_terms: D004322:Drainage / Q000379:methods*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D049291:Seroma
chemical_list: D015718:Fibrin Tissue Adhesive