Prevention of Hematomas and Seromas

Hematoma and seroma formation in surgical wounds has negative effects on wound healing and subsequent morbidity to patients. This is of particular pertinence in cosmetic procedures in which the patient has chosen to undergo surgery electively. Over the past several decades there has been considerable interest in the use of ancillary techniques to assist in closing wounds and achieving hemostasis to prevent hematoma and seroma formation. These techniques include application of tissue sealants or platelet gels, application of quilting sutures, and the use of sclerotherapy to obliterate chronic seromatous cavities. The experience with these techniques in a multitude of surgical specialties is positive and additionally supported in animal models. However, the experience within the plastic surgery literature is mixed. This suggests minimal benefit of ancillary procedures over basic principles of surgical hemostasis and the use of postoperative closed suction drains. Presented here is a summary of the evidence reported using these techniques. Despite the questionable efficacy of these techniques, further appropriated investigations should be performed before eliminating these potentially beneficial adjuncts.