Role of subcutaneous vacuum suction drain in prevention of abdominal wound complication in emergency laparotomy

Background: Some of the most common wound complications following laparotomy include hematoma formation, seroma formation, wound infection, burst abdomen and wound dehiscence. Closed-suction drains (CSDs) help to drain any wound collection and also reduce any dead space in the wound thereby promoting healing and preventing complication.Methods: We conducted a prospective study and included patients presenting with acute abdomen in emergency department. Patients were selected as per inclusion and exclusion criteria. Two groups (group A and B) with equal number of patients were created based on closed envelope technique. CSD was placed in the wound of patients in group A. Wound healing and complications were compared between the two groups.Results: 50 patients were included in the study with 25 in each group. Hematoma formation was found to be significantly more among group B (24.0%) compared to group A (4.0%). Seroma formation (p value =0.03917), SSI rate (p value =0.039) and wound dehiscence/burst abdomen (p value =0.0415) was more in group B than group A. The mean wound healing time (days) and mean hospital stay (days) was significantly more in group B.Conclusions: Placing a subcutaneous vacuum suction drain at the time of abdominal wall closure during emergency laparotomy results in better wound healing and reduces postoperative wound complication, hospital stay time, morbidity and also decreases overall healthcare cost.

Role of Closed Suction Drain in the Prevention of SSI in Elective Surgery

Presence of haematoma, serous fluid, and dead space in a wound increase the risk of infection as they act as a culture media. Multiple options had been mentioned to reduce these risks. We tried to assess the incidence of SSI following placement of closed suction drains following elective surgeries. Methods: A prospective observational study was conducted in the Department of General Surgery, IPGMER & SSKM Hospital, Kolkata from January 2016 to June 2017. Patients who were given a subcutaneous suction drain after an elective general surgical procedure were included in the study. Patients unwilling to take part in the study, patients from paediatric age group, on steroids, with Class 4 wounds and those underwent Laparoscopic Surgery were excluded. Outcome was measured in the form of presence or absence of SSI and data was analysed. Results: No statistically significant decrease of incidence of SSI was found in terms of different age, sex, socio-economic status, duration of hospital stays, smoking or alcoholism. Increased incidence of SSI was detected among Diabetics even after using closed suction drainage. Conclusion: Placement of closed suction drain did not significantly reduce incidence of SSI following elective general surgical procedures.

The role of subgaleal suction drain in chronic subdural hematoma evacuation – Retrospective study in a tertiary care centre

Background: Chronic subdural hematoma (CSDH) is one of the common problems seen in neurosurgical practice, especially in the elderly. Chronic subdural hematoma is a pseudo-encapsulated collection of old blood between the duramater and subarachnoid caused by tear of bridging veins. Materials and methods: Total of 186 patients have underwent burr hole evacuation for subdural hematoma in the study period according to the medical records. Of which 93 had a subgleal drain and rest 93without the drain. Results: The mean GCS at admission was 14 (+/- 1). Out of total 186 patients, 164 (88%) patients had unilateral CSDH and 22(12%) had bilateral CSDH. Among 164 patients with unilateral CSDH 82 (50%) and out of 22 with bilateral CSDH 11 (50%), subgaleal vacuum drain was placed. In rest of 82 (50%) patients with unilateral and 11 (50%) bilateral CSDH, drain was not used. Conclusions: Chronic sub dural hematoma is a common presentation to the neurosurgeon. The present retrospective, comparative study of evacuation of chronic SDH with subgaleal suction drain, and without drain were compared and found to be an effective and safe method in reducing recurrence.

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

BACKGROUND: Postoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability. METHODS: This was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15. RESULTS: The remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application. CONCLUSIONS: With a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

Can We Prevent a Postoperative Spinal Epidural Hematoma by Using Larger Diameter Suction Drains?

BACKGROUND: Epidural hematoma is a rare but serious complication. According to previous studies, it is not prevented by suction drains. This study evaluated the following alternative hypothesis: the larger the diameter of a suction drain, the less the remaining epidural hematoma after spinal surgery. METHODS: This was a randomized prospective study. Patients who underwent posterior lumbar decompression and instrumented fusion were divided into two groups: the large drain (LD, 2.8-mm-diameter tube) and small drain (SD, 1.6-mm-diameter tube) groups according to the diameter of the suction drains. All patients were consecutive and allocated alternately according to the date of operations. Suction drains were removed on day 3 and magnetic resonance imaging was performed on day 7 postoperatively. The size of remaining hematomas was measured by the degree of thecal sac compression in cross section using the following 4-point numeric scale: G1, less than one quarter; G2, between one quarter and half; G3, more than half; and G4, more than subtotal obstruction. RESULTS: There were 39 patients with LDs and 38 with SDs. They did not differ significantly in terms of sex, number of fusion segments, revision or not, antiplatelet medication, intraoperative injection of tranexamic acid. However, patient age differed significantly between the two groups (LD, 63.3 years and < SD, 68.6 years; p = 0.007). The two groups did not differ significantly in terms of prothrombin time, activated partial thromboplastin time, platelet number, blood loss, or operation duration. However, platelet function analysis exhibited a significant difference (LD, 164.7 seconds and < SD, 222.3 seconds; p = 0.002). The two blinded readers showed high consistency (Kappa value = 0.740; p = 0.000). The results of reader 1 were as follows: LD and SD had 21 and 21 cases of G1, 9 and 11 cases of G2, 6 and 6 cases of G3, and 3 and 0 cases of G4, respectively. The results of reader 2 were as follows: LD and SD had 22 and 23 cases of G1, 7 and 9 cases of G2, 7 and 6 cases of G3, and 3 and 0 cases of G4, respectively. There was no difference between the two groups (reader 1, p = 0.636; reader 2, p = 0.466). CONCLUSIONS: The alternative hypothesis was rejected. Therefore, postoperative spinal epidural hematoma would not be prevented by LD.

Is a Suction Drain Necessary in Arthroscopic Rotator Cuff Repair?

BACKGROUND: The purpose of this study was to evaluate the efficacy of suction drain use following arthroscopic rotator cuff repair by comparing early pain score and range of motion (ROM) between groups with and without suction drains. METHODS: The study included 153 patients with rotator cuff tears who underwent arthroscopic repairs at our clinic from April 2014 to March 2015. Following surgery, a suction drain was used in 85 patients (group D) and not used in 68 patients (group ND). There was no statistical difference between the groups in terms of age, gender, or total operation time. The clinical outcome with regard to pain (assessed by pain scores and analgesic requests) and passive ROM was assessed preoperatively and postoperatively. RESULTS: Immediate postoperative analgesic requirement was significantly higher in group D (p=0.001), although there was no difference in pain outcomes between the groups during the 3-month follow-up period. A statistically significant difference in passive ROM was observed at the postoperative 2- and 6-week follow-ups (p=0.036, 0.035, and 0.034 in forward elevation (FE), external rotation at the side (ER) and 90 ER at weeks 2, respectively; 0.045 and 0.009 in FE and ER at weeks 6, respectively); however no significant difference was observed at the end of 3 months. During the study period, no complication was reported in either group. CONCLUSIONS: Use of suction drains after arthroscopic rotator cuff repair provided little benefit in terms of ROM or pain in the early postoperative period (up to 3 months).

Is a Suction Drain Necessary in Arthroscopic Rotator Cuff Repair?

BACKGROUND: The purpose of this study was to evaluate the efficacy of suction drain use following arthroscopic rotator cuff repair by comparing early pain score and range of motion (ROM) between groups with and without suction drains. METHODS: The study included 153 patients with rotator cuff tears who underwent arthroscopic repairs at our clinic from April 2014 to March 2015. Following surgery, a suction drain was used in 85 patients (group D) and not used in 68 patients (group ND). There was no statistical difference between the groups in terms of age, gender, or total operation time. The clinical outcome with regard to pain (assessed by pain scores and analgesic requests) and passive ROM was assessed preoperatively and postoperatively. RESULTS: Immediate postoperative analgesic requirement was significantly higher in group D (p=0.001), although there was no difference in pain outcomes between the groups during the 3-month follow-up period. A statistically significant difference in passive ROM was observed at the postoperative 2- and 6-week follow-ups (p=0.036, 0.035, and 0.034 in forward elevation (FE), external rotation at the side (ER) and 90 ER at weeks 2, respectively; 0.045 and 0.009 in FE and ER at weeks 6, respectively); however no significant difference was observed at the end of 3 months. During the study period, no complication was reported in either group. CONCLUSIONS: Use of suction drains after arthroscopic rotator cuff repair provided little benefit in terms of ROM or pain in the early postoperative period (up to 3 months).

Effective Position of Closed Suction Drain in Inguinal Hernia Surgery: A Retrospective Study.

Background: The aim of this study was to assess the efficacy of closed suction drains in inguinal hernia surgery inserted up to the base of the scrotum as compared to those in which the drain is limited to the inguinal region. Methods: Data of all lichtenstein hernioplasty from January 2012 to December 2014 in M. S. Ramaiah Medical Hospital were collected retrospectively. A total of 992 patients underwent hernia repair and only 133 patients were subjected to closed suction drain. In 133 patients data were collected regarding the type of presentation, age, gender, presence of coexisting diseases, type of hernia, type of anesthesia, postoperative general complications, data was collected regarding the presentation of the hernia, type of sac encountered, amount of dissection, location of the inserted drain, complications, and length of hospital stay. These patients were followed up for 6 months. Local wound complications, duration of operation, and length of hospitalization, recurrence and mortality were compared between the groups of patients with drains versus without drains. Results: Average amount of drain fluid was higher (58.5 ml) in the group where the drain was inserted to the bottom of the scrotum as compared to (22.4 ml) the group with the drain limited to the inguinal region. Furthermore, there was significant difference in the incidence of scrotal edema in the two groups (6 vs. 23). Hence, by positioning the drain to reach the bottom of the scrotum; it will lead to a better drainage of the collection and in turn lead to fewer associated complications such as scrotal hematomas, infections, and scrotal edema. Conclusion: In our study, placement of drain extending into the bottom of scrotum significantly reduced scrotal edemas a result alleviates immediate post-operative patient anxiety and morbidity in the reduction of scrotal size to normal. However, it requires a larger series to confirm our early observations.

Drain tip culture following total knee arthroplasty.

Background: Placing a suction drain following total knee replacement is usual practice which is been followed by many surgeons. Closed suction drainage following arthroplasty is a routine with the aim of preventing wound hematoma and thereby reducing the risk of infection. Surgical site infections (SSI) in orthopaedic surgeries are disastrous and often lead to significant morbidity and mortality. Usefulness of drain tip culture in predicting the wound infection is been tested but results are controversial. Methods: It is a prospective study of 546 drains (352 patients) who underwent unilateral or bilateral Total Knee Arthroplasty (TKA). The drain tip was sent for culture at the time of removal. Cultures from the SSI were also collected. Cases that had at least six months of follow up were included in the study. Results: Drain tip culture was positive in total of 18 patients. Three patients had developed deep infection and 10 patients had superficial infection. All three patients with deep infection and 9 out of 10 patients of superficial infection were drain tip culture positive. Out of 9 culture positive superficial infections, one had different bacteria identified from the wound site. Drain tip culture was positive in 3.39% of drains and infection (wound culture) was positive in 2.26% of wounds. On statistical analysis we found drain tip culture has sensitivity of 91.66%, specificity of 98.64%, positive predictive value of 61.11% and negative predictive value of 99.8%. Conclusion: Drain tip culture positivity helps in predicting the future chance of developing the infection. If drain tip culture is negative, then there is almost near nil chances of infection.

Epidural Fibrosis after Lumbar Disc Surgery: Prevention and Outcome Evaluation

STUDY DESIGN: This is a prospective, randomized, controlled study designed and conducted over 10 years from 2002 to 2012. PURPOSE: The study aimed to monitor the effect of suction drains (SD) on the incidence of epidural fibrosis (EF) and to test, if the use of SD alone, SD with local steroids application, SD combined with fat grafts and local steroids application, or SD combined with fat grafts and without local steroids application, would improve outcome. OVERVIEW OF LITERATURE: EF contributes to significant unsatisfactory failed-back syndrome. Efforts have been tried to reduce postoperative EF, but none were ideal. METHODS: Between September 2002 and 2012, 290 patients with symptomatic unilateral or bilateral, single-level lumbar disc herniation were included in the study. Two groups were included, with 165 patients in group I (intervention group) and 125 patients in group II (control group). Group I was subdivided into four subgroups: group Ia (SD alone), group Ib (SD+fat graft), group Ic (SD+local steroids), and group Id (SD+fat graft+local steroids). RESULTS: The use of SD alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome and significantly reduced EF as measured by magnetic resonance imaging (MRI). CONCLUSIONS: This study has clearly demonstrated the fact that the use of suction drainage alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome with respect to pain relief and functional outcome and significantly reduced EF as measured by an MRI. A simple grading system of EF on MRI was described.

Utilidad del drenaje aspirativo en el postoperatorio de cirugía ortopédica / Usefulness of postoperative suction drainage in orthopedic surgery

El objetivo de la investigación es determinar la utilidad del drenaje aspirativo en el postoperatorio de Cirugía Ortopédica en el Hospital Universitario de Maracaibo, estado Zulia, Venezuela. Se realizó una investigación descriptiva, prospectiva y longitudinal con un diseño no experimental. Los pacientes seleccionados fueron todos los llevados a cirugía electiva y que cumplían con los criterios de inclusión. Se aplicó el método estadístico de Chi-cuadrado y "t" de Student, para determinar las diferencias significativas, entre los pacientes que reciben tratamiento quirúrgico y los que no lo reciben. Se consideró p < 0,05 como estadísticamente significativa(AU)

The objective of the investigation is determining the usefulness of postoperative suction drainage in orthopedic surgery in the University Hospital of Maracaibo, Zulia state, Venezuela. A descriptive, prospective and longitudinal investigation is realised with a nonexperimental design. The selected patients are those that are carried elective surgery and who meet the inclusion criteria. The statistical method Chi-cuadrado and the t" of Student is applied, to find if there are or significant nondifferences between the patients who receive surgical treatment and those that do not receive it. P< 0,05 is considered like statistically significant(AU)

The Efficacy of Suction Drains arter Total Hip Arthroplasty

Purpose: The goal of this study was to evaluate the efficacy of suction drains following total hip arthroplasties, by comparing the post-operative results between the group with suction drains and the group without suction drains. Materials and Methods: Eighty-six patients, who underwent primary total hip arthroplasties from June 2001 to June 2004, were divided into two groups: group 1 (48 patients), with suction drains; and group 2 (38 patients), without suction drains. We assessed the perioperative hemoglobin and platelet levels, the amount of total blood loss, the amount of post-operative blood transfusions, post-operative ranges of motion (ROMs, at 6 weeks), wound problems, and general conditions. Results: Although the postoperative hemoglobin level was greater in group 2 than in group 1, there was no statistically significant difference. The amount of total blood loss and blood transfusions in group 1 were statistically greater than in group 2 (p<0.05). There were no statistically significant differences in the post-operative ROMs and wound complications between groups 1 and 2. Conclusion: There were no limitations of hip motion and no wound complications in the patients without suction drains after total hip arthroplasties. However, they required fewer post-operative blood transfusions than did the patients with suction drains, due to less post-operative blood loss; and the absence of a suction drain might prevent retrograde tube infections. In addition, patients without suction drains after total hip arthroplasties seemed to recover better did than those with suction drains. Therefore, suction drains might provide no benefit in total hip arthroplasties.

Is Suction Drainage Necessary after Total Knee Arthroplasty? / 대한정형외과학회잡지

PURPOSE: To assess the effectiveness of suction drainage following total knee arthroplasty in terms of blood-saving and local complications. MATERIALS AND METHODS: A total of 67 patients who underwent primary total knee arthroplasty were evaluated. There were 35 drained and 32 undrained total knee arthroplasties. The total amount of blood loss and transfused were calculated in each patient. Any local or systemic complications were recorded. RESULTS: No significant difference was noted between drained and undrained total knee arthroplasties regarding; wound healing, recovery of knee motion, or associated local or systemic complications. However, blood loss (1078 cc versus 298 cc) and transfusion amounts (2.8 unit versus 0.6 unit) were significantly higher in the drained group than in the undrained group. CONCLUSION: Following primary total knee arthroplasty, a lack of drainage did not cause significant wound healing problems, but it reduced blood loss and transfusion requirements. Wound drainage following total knee arthroplasty has been a tradition, but this study shows no benefits from a postoperative drainage system in primary total knee arthroplasty.