Seroma formation is a difficult problem to treat and prevent. Its sequelae include wound infection, dehiscence, and skin-flap necrosis. The purpose of this study was to determine the effects of fibrin sealant on seroma formation and wound healing. Seromas were created in a rat model by harvesting the latissimus dorsi muscle. In group I (n = 20), only the latissimus dorsi muscle was harvested. In group II (n = 20), the latissimus dorsi muscle was harvested and fibrin sealant applied. Seromas were routinely aspirated. In group III (n = 20), the latissimus dorsi muscle was harvested, and once a seroma was evident clinically, it was aspirated and injected with fibrin sealant. Fibrin sealant was created by combining virally deactivated fibrinogen and thrombin (American Red Cross, Rockville, Md.). In group I, 90 percent of the animals formed seromas compared with only 20 percent in group II. The average total fluid aspirated in group I was 21 cc versus 6 cc in group II. Sixty percent of the animals in group I and 5 percent in group II required serial drainage for chronic seromas. Skin-flap necrosis occurred in 80 percent of the animals in group I, in 10 percent of group II, and in 40 percent of group III. Histologic evaluation confirmed that group II underwent better wound healing. At necropsy, group I animals with seromas had gross capsular formation; this was not readily apparent in the fibrin sealant groups. We conclude that (1) the harvesting of the rat latissimus dorsi muscle is a reliable model for creating seromas, (2) fibrin sealant effectively prevents seroma formation when applied intraoperatively, (3) wound healing in the seroma rat model is improved with intraoperative fibrin sealant application, (4) closed injection of fibrin sealant for existing seromas cannot be recommended at this time, (5) virally deactivated fibrin sealant retains its hemostatic and adhesive properties, and (6) current clinical trials of virally deactivated fibrin sealant may facilitate its use in the United States.

We report a case of Candida albicans prosthetic valve endocarditis in a patient who was still alive 1 year following a homograft aortic root and valve replacement and antifungal therapy. Only 33 other cases of successfully treated fungal prosthetic valve endocarditis have been reported. We review these 33 cases and six cases of late recurrence following treatment, as well as the clinical features, diagnosis, and options for treatment of fungal prosthetic valve endocarditis.

A common complication of soft tissue dissection and muscle harvesting is seroma formation. In order to manage and understand the formation of seromas, we developed a small animal model for seromas in the Sprague Dawley rat. Skin flaps and subcutaneous tissue were elevated and the latissimus dorsi muscle was harvested in 20 animals. Eighteen of the 20 rats (90%) formed clinically significant seromas. Sixteen animals had associated skin flap necrosis and 12 required serial drainage for recurrent seromas. At necropsy, gross capsular formation occurred in all animals who developed seromas. Microscopically, a fibrous capsule enveloping the seroma was seen associated with a local chronic inflammatory cell infiltrate. We conclude: (1) Elevation of the latissimus dorsi muscle in the rat is a reliable and practical animal model for seroma formation; (2) Sequelae of clinically significant seromas are often as severe as skin flap necrosis; (3) An inflammatory reaction may be associated with seromas.