the presence of postoperative seromadesis is common , corresponding to the presence of serum in the subcutaneous tissue post a surgical event .
we present a case of a 63-year - old woman having undergone femoral prosthesis surgery and total hip replacement with a subfacial seroma without findings of infection , refractory to standard treatment of compression bandages , massage and cleaning surgery in two oportunities .
a literature review was undertaken to obtain the therapeutic alternatives where erythromycin seromadesis is chosen with excellent response .
erythromycin sclerotherapy should be considered as an effective and safe option in the treatment of seroma in general surgery and traumatology .
we believe that this is the first study of use of erythromycin as sclerotherapy in a traumatology case .
a seroma is the collection of fat , liquid , serum and lymph in one area of the body following a traumatic or surgical event .
usually , it is formed in a wound in the immediate postoperative period , usually in the first week , although it may be delayed .
generally it is benign , but often annoying to the patient and has a moderate risk of infection .
the presence of a seroma may be asymptomatic , or may have swelling , pain and exude from the wound
. the diagnosis can be by inspection and palpation of the wound , with computed tomography and the ultrasound beign useful for identifying fluid collection .
seroma s have been seen in orthopaedic surgery as well , where they are likely to have serious repercussions .
this is true especially in prosthetic surgery , with greater chances of infection of prosthetic components and failure of the joint replacement associated with high costs , lengthy hospitalizations , and at times need for a subsequent surgery .
treatment options can be categorized as preventive or curative , xonsisting of intraoperative application of sclerosing chemicals as hypertonicsaline   and talc   in humans and gram positive anaerobe like corynebacterium parvum in rat models , tissue adhesives ( fibrin or platelet concentrates ) , use of negative pressure drainage , repeated percutaneous aspiration and surgical drainage with complete removal of seroma and its capsule .
the use of erythromycin as a sclerosing agent was described in animal studies , that was first assessed as a pleural sclerosant , proving effective and with fewer sideeffects than talc , tetracycline and diazepam .
this is used safely in humans in the management of breast surgeries , non neoplastic ovaran cysts   and pleurodesis .
there are no reports of its use in orthopedics , and we believe that this is the first study of this kind .
a female patient of 63-year - old presented to our orthopaedic department with prosthetic loosening of the isoelastic stem ( fig .
1 ) , also femur and acetabulum with massive osteolytic defect performed by modular aloprosthesis of proximal femur and acetabulum of tantalum , and metal on polyethylene pair of friction ( fig .
patient had good clinical evolution with the drain removed at the first postoperative day with output of 100 cc .
five days later , patient was re - admitted to the emergency room for increased volume in relation to wound without infectious signs .
3 ) . cemented total hip arthroplasty left hip , with extensive osteolysis in bone cement interface .
. soft tissue ultrasonography , in hypodermic one hypoechoic collection of 10.5  4.0  4.6 cm . to avoid superinfection of a large extent surgery
, it was decided to make an early cleaning surgery , in order to drain and take tissue samples and fluid culture .
a collection is located under muscle planes adjacent to the aloprotesis , with communication between up fascia lata muscleplane .
after the cleaning surgery and drainage , equally the seroma is maintained for 5 days with daily output of 200 cc of serous fluid .
it was decided to perform a new scouring , with obliteration of third space , massage and compression bandages .
negative cultures were obtained . given the persistence of seroma , a literature review was undertaken to obtain therapeutic alternatives .
finally , surgical cleanliness was performed with resection of pseudocapsule seroma with curettage , making crops and application of 2 g. erythromycin diluted in 200 cc.of 0.9% saline solution .
customary closing was performed flat leaving a aspiration drainage n 9 undert he fascia , which was measured daily .
the next day , the drainage measured serohematic liquid 100cc , and 60cc was measured on the 2nd day . on the 3rd day , 10 cc of liquid was measured , and the drainage was removed on the 4th day .
subsequently , the patient was discharged in good condition without signs of infection , tension , edema or collection in the thigh wound .
it has been assessed that there are certain factors that could favor the formation of seroma , such as a high bodymass index , use of electrocautery to dissect , early withdrawal of drain ( within 24 hours ) , obliteration of dead space and use of drains under vacuum . in our case
, it is highlighted that the drainage was removed on the first postoperative day , which could have favored the formation of seroma .
although , maintaining a drainage for more number of days also increases the risk ofinfection .
it is important to consider the differential diagnosis of surgical wound infection , hence blood inflammatory parameters were evaluated , and fluid cultures of the wound were taken . if an infection is confirmed , systemic antibiotic treatment should be given .
in addition , open the wound , drain the liquid and perform irrigation and debridement folllowed by wound closure . in the search for bibliographical studies , with terms 
mesh  in pubmed for  seroma  and  erythromycin  a single study was located , ali - khan et al .
2009 , which refers to the use of erythromycin as sclerotherapy in the management of seroma in series of patients of plastic surgery , showing effectiveness and no serious complications .
the search for terms  mesh  in pubmed for  seroma  and  sclerotherapy  , located two investigations , throckmorton et al . in 2008 with povidoneiodine or ethyl alcohol in postmastectomy   and moritz et al . in 2013 with polidocanol in varicose vein surgery .
the current evidence allows the use of this therapy in this patient , although there is no evidence in trauma surgery .
it is necessary to conduct more studies to evaluate the effectiveness and reproducibility of this therapy .
it is known that erythromycin as sclerosing product tends to be very effective with fewer adverse effects than other compounds used for the same condition .
it has evaluated with satisfactory results in pleurodesis , non - neoplastic adnexalcyst , and plastic surgery .
erythromycin use as sclerosing product in orthopedic surgery must be evaluated as a effective and safe therapeutic alternative .
 introduction : the presence of postoperative seromadesis is common , corresponding to the presence of serum in the subcutaneous tissue post a surgical event . 
 erythromycin has been reported as sclerosing , although not in orthopedic surgery . 
 we report a case of erythromycin seromadesis in orthopedic surgery.case presentation : we present a case of a 63-year - old woman having undergone femoral prosthesis surgery and total hip replacement with a subfacial seroma without findings of infection , refractory to standard treatment of compression bandages , massage and cleaning surgery in two oportunities . 
 a literature review was undertaken to obtain the therapeutic alternatives where erythromycin seromadesis is chosen with excellent response.conclusion:erythromycin sclerotherapy should be considered as an effective and safe option in the treatment of seroma in general surgery and traumatology . 
 more studies are necessary to get a better evidence . 
 we believe that this is the first study of use of erythromycin as sclerotherapy in a traumatology case . 
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Introduction
Case Presentation
Discussion
Conclusion