Closed Suction Drain Placement Using a Carroll Tendon Retriever.

Abstract

The technique used for closed suction drain placement in plastic surgery is dependent on surgeon preference and experience. Drains assist in preventing accumulation of inflammatory seroma fluid, but they also present a possible nidus for infection, which is particularly concerning in implant-based breast reconstruction. Murray et al.1 retrospectively reviewed 200 cases of breast reconstruction with tissue expander placement and found that subcutaneous tunneling is one factor that may defend against infection by means of in vivo protection of the prosthesis from the drain. This clinical practice is echoed in the neurosurgery literature, where several studies have shown that long subcutaneous tunneling decreases the incidence of surgical site infection in neurosurgical procedures.2,3 Yoshida et al.4 recently described a method of drain placement into the breast pocket utilizing a liposuction cannula. While their method is innovative and effective, we would like to propose another technique with the similar advantage of using readily available operating room instruments but that is simpler and more ergonomic. The method utilizes a Carroll tendon retriever, commonly referred to as a tendon passer by plastic and hand surgeons, to place a tunneled closed-suction drain for implant-based breast reconstruction through a long subcutaneous plane with minimal disruption and stress to surrounding tissues. We begin by selecting a drain insertion site lateral to the breast pocket at the level of the inframammary fold to allow for at least 5 cm of subcutaneous tunneling. This location permits the scar to be hidden by a bra. After creating a stab incision, the surgeon inserts a Carroll tendon retriever with jaws closed and advances it manually with gentle, constant pressure through the subcutaneous plane into the breast pocket. The jaws are then opened to grasp the external end of the drain and draw it out from the upper outer breast pocket through the tunnel. The drain is secured with nonabsorbable suture and dressed with a sterile adhesive dressing. [See Video (online), which demonstrates the use of a Carroll tendon retriever to facilitate drain placement into a breast pocket.] {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"This video demonstrates the use of a Carroll tendon retriever to place a drain tube into a breast pocket.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_acjzm5ek"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} The Carroll tendon retriever has several advantages over other common methods of placing tunneled drains. This technique facilitates atraumatic creation of a long subcutaneous tunnel. In contrast to either a tonsil or a hemostat, both of which have a shank that splays widely toward the handle in the tissue, the Carroll tendon retriever has a static, narrow body that forms a uniform-sized tunnel. Its blunt tip makes it a safer alternative to using a trocar for drain placement. Lastly, the Carroll tendon retriever is well known to plastic and hand surgeons and is reusable and reasonably inexpensive. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No direct funding was provided for this study.