When the development of a wound seroma is a potential problem after an appendectomy in an obese patient, the best effective method of wound management is
Closing the wound with a closed suction drain With a clean-contaminated wound after an appendectomy, it should not be necessary to leave the wound open. In an obese patient, seroma in the wound is a possibility, and primary wound closure might not be appropriate. Rubber drains act as a route for bacteria to enter the wound, and multiple subcutaneous cultures provide foreign bodies as a nidus for possible infection. The best option is to close the wound carefully over a closed-suction drain. Whatever method is used, all devitalized tissue should be removed and careful hemostasis accomplished before the procedure is completed. Although wound irrigation with an antibiotic solution is frequently used, there is no solid evidence that this reduces the likelihood of wound infection.
Leaving the subcutaneous tissue and skin open to heal by secondary intention
Closing the wound over a rubber drain
Closing the wound with a closed suction drain
Closing the wound with multiple sutures in the subcutaneous tissue