Objective: Despite improved recognition of risk factors, plastic surgeons commonly encounter seromas postoperatively and must decide upon management. Current recommendations for minimally invasive, chemical management originate from the literature on management of pneumothorax and pleural effusions. A handful of published reports have suggested the efficacy of sclerotherapy in seroma management. The aim of this study was to assess the literature on the use of sclerosants to treat subcutaneous fluid collections. Methods: A systematic review of the literature was performed on the PubMed, MEDLINE, and Cochrane databases for primary research articles on sclerotherapy for seroma treatment between January 1975 and January 2017. Exclusion criteria were surgical treatment, sclerotherapy for seroma prevention, hematoma, or absence of detailed documentation. Data related to seroma location, sclerosant, and resolutions were extracted. Results: The literature search yielded 7 relevant articles of level IV evidence and 12 case reports, with a total of 84 patients treated with sclerotherapy for persistent seromas. Slerosant included talc, tetracycline antibiotics, ethanol, polidocanol, erythromycin, OK-432, fibrin glue, and povidone-iodine. All agents achieved high rates of success. Repeat aspirations and instillations were easily performed when required. Complications, while uncommon, included pain, tightness or discomfort of the treated area, and infection. Conclusion: Sclerotherapy appears to be effective and safe for recurrent seromas. While a variety of sclerosing agents may be applied successfully, talc and tetracyclines remain popular choices. Because of the small scale and retrospective nature of the published literature, larger, randomized, comparative studies are necessary to assess and optimize this treatment approach.

Sclerotherapy for the Management of Seromas: A Systematic Review.

Abstract A post-operative fluid collection (POFC) represents a common finding in both primary and revision total joint arthroplasty (TJA). Fortunately, most resolve on their own, but in instances where they become symptomatic, prompt identification and management are paramount, especially when they occur adjacent to a joint arthroplasty because of the increased the risk of developing a periprosthetic joint infection. A strong clinical suspicion with appropriate clinical exam is required along with select imaging modalities to arrive at a diagnosis. Meticulous surgical technique is crucial to prevent POFC, but new emerging treatments continue to evolve. This article presents an updated overview of incidence, pathophysiology, diagnosis, and management of POFC in the setting of TJA. We review the role of select imaging modalities as well as summarize current literature regarding new treatments such as sclerotherapy agents, acellular dermal matrices, and negative pressure wound therapy. Future studies are necessary to explore the interplay of inflammatory mediators in POFC formation and to define their role in fluid collection resolution.

Postoperative Fluid Collections in Total Joint Arthroplasty: A Narrative Review

The authors describe their experience in successfully treating an isolated Morel-Lavallee lesion of the lumbar spine after delayed presentation. In addition to thorough irrigation, debridement, and pseudo-capsulectomy, surgical management included transcutaneous transmyofascial bolstering with a progressive tension suturing technique to close the cavity over drains in a "quilting" fashion. This was followed by 6 days of incisional wound vacuum treatment and 13 days of drainage through 2 Jackson-Pratt drains. At 6-month follow-up, the patient noted resolution of pain and return to baseline level of functioning. No evidence of recurrence was noted. The Morel-Lavallee lesion of the low back represents a difficult soft tissue injury to treat with substantial risk of complications and recurrence. Diagnosing and treating physicians should be familiar with common injury mechanisms and clinical presentations, as well as a variety of nonoperative and operative treatment options. [Orthopedics. 2019; 42(4):e399-e401.].

Successful Treatment of Morel-Lavallée Lesion of the Back With Transcutaneous Transmyofascial Bolstered Progressive Tension Suturing.

Morel-Lavallee lesions are chronic seromas due to closed degloving injuries, resulting from blunt trauma. They most commonly occur over the greater trochanteric, gluteal and flank regions. We prese...

https://www.birpublications.org/doi/pdf/10.1259/bjrcr.20190120

Retrosacral Morel-Lavallée lesion: resolution with ultrasound-guided drainage and sclerotherapy.

A post-operative fluid collection (POFC) represents a common finding in both primary and revision total joint arthroplasty (TJA). Fortunately, most resolve on their own, but in instances where they become symptomatic, prompt identification and management are paramount, especially when they occur adjacent to a joint arthroplasty because of the increased the risk of developing a periprosthetic joint infection. A strong clinical suspicion with appropriate clinical exam is required along with select imaging modalities to arrive at a diagnosis. Meticulous surgical technique is crucial to prevent POFC, but new emerging treatments continue to evolve. This article presents an updated overview of incidence, pathophysiology, diagnosis, and management of POFC in the setting of TJA. We review the role of select imaging modalities as well as summarize current literature regarding new treatments such as sclerotherapy agents, acellular dermal matrices, and negative pressure wound therapy. Future studies are necessary to explore the interplay of inflammatory mediators in POFC formation and to define their role in fluid collection resolution. 

Morel-Lavallee seroma (MLS) or post-traumatic pseudocyst is a soft tissue seroma developing due to closed degloving injury by a shearing force that causes separation of subcutaneous fatty layer from the deeper muscular fascia resulting in collection of fluid in the created space. Presentation is usually fluctuant swelling following history of injury. More frequently described in orthopaedic literature, it occurs more commonly over gluteal and trochanteric regions, knee and flanks with occurrence over back, thorax being a rare entity. Despite mimicking several other similar presenting conditions, diagnosis of MLS can be made by meticulous history and physical examination with classical findings on ultrasonography, CT scan and MRI. Treatment modality may vary from conservative management to open surgical debridement of the wound with percutaneous aspiration and sclerodhesis forming useful adjuncts to conservative management.

/pdf/morel-lavallee-seroma-post-traumatic-pseudocyst-of-back-a-1v03y3okcr.pdf

Morel-Lavallee seroma (post-traumatic pseudocyst) of back: a rarity with management conundrum.

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Morel-Lavallee seroma (post-traumatic pseudocyst) of back: a rarity with management conundrum.