Independent predisposing factors for subcutaneous and deep wound collection after total thyroidectomy, a prospective cohort study

Abstract

BackgroundThe literature contains diverse and sometimes contradicting results about wound seroma following thyroidectomy. This is probably due to the subjective clinical estimation of seroma, or due to failure to differentiate between the occurrence of subcutaneous (SC) and deep wound collections. This work aimed at objectively investigating the factors affecting subcutaneous and deep wound seroma after thyroidectomy.MethodsThe relation between various operative and clinico-pathological factors and the collection formation was prospectively analyzed in a cohort of 100 patients after conventional thyroidectomy. Wound seroma was assessed clinically and via high-resolution ultrasonography at 24 h, 48 h and two weeks postoperatively. Sonographically detected collections were expressed as SC and/or deep wound collections according to the relation to strap muscles.ResultsOperative duration was the only independent factor significantly affecting the incidence of clinical seroma. Older patients (>40ys) showed significantly larger volumes of early SC collections. Early postoperative pain was significantly related to drain insertion, to the occurrence of clinical seroma and to the volume of SC collections.Sonographically, suction drains and shorter operative durations resulted in significantly less amount of deep collections. Suction drains did not result in less amount of SC collections or in a lower incidence of clinical seroma.ConclusionsOperative duration is the only independent factor significantly related to clinically-detected postoperative seroma with its subsequent postoperative pain. Especially in elderly patients, a flapless technique would be recommended as these patients developed larger volumes of SC collections with subsequent higher pain scores, even if seroma was not clinically detected.

Effectiveness of Drainless Thyroidectomy in Terms of Postoperative Bleeding-a Randomized Controlled Trial

“…Successful management of all complications with palliative care was reported which is similar to the literature worldwide. [15][16][17][18] Nevertheless, wound complications that likely occurred in the drained group in our study cannot be ignored, owing to the drain placement. Hence drains predispose wounds to the development of infections.…”

The effect of fibrin glue on the quantity of drainage after thyroidectomy: a randomized controlled pilot trial

“…However, while hemostatic effects are well documented in other fields, its ability to reduce or prevent a seroma formation in the operative field remains controversial in thyroid surgery [ 5 6 ]. Regarding this issue, it has been reported that clinicopathologic factors, such as age, sex, body mass index (BMI) or dead space, the amount of fibrin glue used, and surgeon’s skill, may affect the outcome; therefore, the data on these factors should be collected to evaluate the actual impact of fibrin glue on the prevention of seroma after thyroidectomy [ 5 7 8 ].…”