Background: Postoperative seroma remains one of the most persistent and clinically frustrating complications across multiple surgical specialties, particularly breast surgery, ventral hernia repair, reconstructive procedures, orthopedic interventions, and complex wound care. Although often treated as a minor sequela, seroma formation may produce pain, delayed healing, repeated aspirations, anxiety, prolonged follow-up, infection risk, and in some cases chronic encapsulated fluid collections that require reoperation. At the same time, regenerative biomaterials derived from decellularized extracellular matrix have emerged as a potentially important adjunct in tissue remodeling, dead-space control, inflammatory modulation, and wound repair. The present study develops an original qualitative integrative analysis based strictly on the supplied reference set.

Objective: To synthesize current knowledge on postoperative seroma pathogenesis, classification, prevention, and management, with particular emphasis on the theoretical and practical role of extracellular matrix-based biologic scaffolds in reducing seroma burden and improving tissue healing.

Methods: A qualitative integrative research design was used. Fifteen provided references were analyzed through comparative thematic synthesis. Sources included surveys, case reports, classification studies, experimental animal work, regenerative medicine reviews, wound-healing studies, and clinical reports. The analysis focused on four domains: mechanisms of seroma formation, limitations of conventional management, principles of extracellular matrix scaffold biology, and translational applications of biomaterials in seroma-prone surgical settings.

Results: The evidence indicates that seroma is best understood as a multifactorial consequence of surgical dead space, disrupted lymphatics, inflammatory exudation, biomechanical shear, and impaired tissue adherence. Existing management strategies remain variable and often reactive. Classification systems improve conceptual precision but are not yet universally integrated into management pathways. Biologic scaffolds appear promising because they do not merely fill tissue deficits; they may also influence host response, recruit progenitor cells, support constructive remodeling, and alter the chronicity of fluid-producing tissue planes. Evidence from preclinical models, wound-care applications, and selected clinical cases supports a rationale for biomaterial-assisted seroma management, though robust comparative trials remain limited.

Conclusion: Seroma management should move from passive drainage-centered thinking toward biologically informed tissue remodeling strategies. Extracellular matrix biomaterials offer a compelling translational framework, but high-quality prospective research is required to define indications, timing, cost-effectiveness, and procedure-specific protocols.

Postoperative seroma, extracellular matrix, biologic scaffolds

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