Closed Wound Suction Drainage Research Articles

Computed tomographic findings, surgical management and postoperative outcomes of large intermuscular lipomas in the hindlimb of 11 dogs.

Lipomas are benign adipose tissue tumours of mesenchymal origin and can originate in various locations. Intermuscular lipomas in the thigh can cause substantial hindlimb expansion in the dog. We describe the computed tomography findings, surgical management and the outcomes of 11 dogs with large intermuscular lipomas of the hindlimb. Retrospective case series. Medical records between 2009 and 2019 of dogs presenting to The Animal Hospital at Murdoch University were reviewed. Inclusion criteria included dogs with a histologically confirmed, large hindlimb lipoma that was surgically excised following preoperative computed tomography (CT) imaging. CT with intravenous contrast revealed a well-defined, smoothly marginated, fat attenuating mass with minimal vascularity, separating the muscle bellies of the caudal hindlimb. The mass was often in close proximity to the femoral artery and vein. All lipomas were marginally excised. At surgery, some lipomas were intimately associated with the sciatic nerve and some showed infiltration of, or attachment to, neighbouring muscle that could be excised en bloc with the lipoma. Postoperative closed-suction wound drainage was used in 6 of 11 dogs. One dog required revision surgery due to partial wound dehiscence. Long-term follow-up with owners reported good postoperative function of the affected hindlimb in all dogs. One dog developed an infiltrative lipoma in the same location 22 months post-excision. Preoperative CT allowed a presumptive diagnosis of intermuscular lipoma and facilitated surgical planning for marginal excision. Large intermuscular lipomas of the hindlimb can be safely excised with minimal short-term complications, good long-term functional outcome and low likelihood of recurrence.

One- or Two-Level Transforaminal Lumbar Interbody Fusion without Closed-Suction Wound Drainage

Background Data: Although many surgeons stopped using closed-suction drainage following simple spine decompression surgery, there is still debate regarding the necessity of wound drainage in more extensive lumbar spine surgical procedures. Purpose: To estimate the advantages and disadvantages of performing one- or two-level transforaminal lumbar interbody fusion (TLIF) without closed-suction drainage. Study Design: Retrospective clinical cohort study. Patients and Methods: The Fast-Track technique was performed in 36 consecutive TLIF surgeries between January and September 2016 without using wound drainage. Twenty-eight patients were females and 8 were males. Thirty patients had single-level TLIF and 6 double-level TLIF. The results of these patient series were retrospectively analyzed. The variables that were reviewed included blood transfusion, postoperative temperature, postoperative pain and the use of opiates during hospital stay, duration of surgery, duration of hospital stay, and incidence of postoperative complications such as neurological deficit, hematoma, postoperative wound infection, and revision surgery. Results: There was no postoperative allogenic blood transfusion; the patients did not develop postoperative neurological deficit; there were no cases of surgical revision as a result of significant postoperative hematoma or infection. There were two cases (5.5%) of revision surgery due to persistent CSF leakage from the wound. Four patients (11.1%) developed serous discharge from the wound, which was treated conservatively with frequent dressing and antibiotics. Four patients (11.1%) developed transient postoperative fever. The mean pain score in the first 2 days after surgery assessed by the Visual Analogue Score (VAS) was 6.1 points, and additional opiate in the first 2 postoperative days was mandatory in 30 patients (83.3%). Conclusion: Performing one- or two-level lumbar decompression and fusion without closed-suction wound drainage did not increase the rate postoperative infection or hematoma formation. Additionally, none of our patients required postoperative blood transfusion. (2018ESJ168)

Is a drain tube necessary for minimally invasive lumbar spine fusion surgery?

This study aimed to evaluate if closed suction wound drainage is necessary in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF). This is a prospective randomized clinical study. Fifty-six patients who underwent MIS TLIF were randomly divided into groups A (with a closed suction wound drainage) and B (without tube drainage). Surgical duration, intraoperative blood loss, timing of ambulation, length of hospital stay and complications were recorded. Patients were followed up for an average of 25.3months. Clinical outcome was assessed using the Oswestry disability index and visual analogue scale (VAS). Fusion rate was classified with the Bridwell grading system, based on plain radiograph. Both groups had similar patient demographics. The use of drains had no significant influence on perioperative parameters including operative time, estimated blood loss, length of stay and complications. Patients in group B started ambulation 1day earlier than patients in group A (p<0.001). Clinical outcomes were comparable between group A and group B. A drain tube can lead to pain, anxiety and discomfort during the postoperative period. We conclude that drain tubes are not necessary for MIS TLIF. Patients without drains had the benefit of earlier ambulation than those with drains.

Comparison Between Subcutaneous Closed-suction Drainage and Conventional Closed-suction Drainage in Adolescents Idiopathic Scoliosis Patients Undergoing Posterior Instrumented Spinal Fusion

Prospective, randomized controlled clinical study. To evaluate the efficacy of subcutaneous closed-suction drainage in reducing blood loss as compared with conventional closed-suction drainage in adolescent idiopathic scoliosis cases undergoing posterior instrumented spinal fusion. Subcutaneous closed-suction drainage is reported to be a reasonable alternative to intra-articular indwelling closed-suction drainage and to that of no usage of any drainage system in knee arthroplasty. However, little is reported about the use of subcutaneous closed-suction drainage in adolescents idiopathic scoliosis patients undergoing posterior instrumented spinal fusion. A total of 105 adolescent idiopathic scoliosis patients undergoing posterior instrumented spinal fusion were randomized into 2 groups of either a subcutaneous drainage or a conventional closed-wound suction drainage system. These 2 groups were compared for demographic distribution, blood loss (hemoglobin/hematocrit changes, transfusion requirements), and incidence of wound problems (requirements for dressing reinforcement, oozing, subcutaneous hematoma, ecchymosis, infection). Mean drainage volume was less (P=0.000) in the subcutaneous closed-wound suction drainage group compared with the conventional closed-wound suction drainage group (42 vs. 631 mL). The groups were statistically similar in terms of hemoglobin and hematocrit values obtained on the third postoperative day (10.60 vs. 9.52 g/dL, P=0.110; 30.85% vs. 27.82%, P=0.226), on discharge (10.90 vs. 9.75 g/dL, P=0.114; 31.10% vs. 28.13%, P=0.147), transfusion requirements (31.2% vs. 45.6%, P=0.133), and incidence of wound problems. However, the core temperature values were higher in subcutaneous closed-wound suction drainage group compared with the conventional closed-wound suction drainage group (P=0.001), and the duration of fever was longer in the former compared with the latter (P=0.008). The data suggest that subcutaneous closed-suction drainage offers a reasonable alternative to closed-wound suction drainage in adolescents idiopathic scoliosis patients undergoing posterior instrumented spinal fusion.

Crushed Muscle Tissue Graft: A Efficient Repair Technique for Intraoperative Chylous Fistulas

ABSTRACT Background/objectives Chylous fistula is an uncommon but serious complication of radical neck dissections and is a complication which can be better avoided than treated. Presence of amber colored lymph in the postoperative closed wound suction drainage is defined as chylous fistula. Materials and methods The study was done over 18 months analyzing neck dissections done for 245 cases for complications of chyle leak. Six cases of chyle leak were identified during the course of the study. Results All the six cases were repaired with crushed muscle tissue graft harvested from the remaining portion of the sternocleidomastoid muscle was spread out and sealed. No chyle leak complications were seen in the drains after the repair. Conclusion The use of crushed local muscle tissue grafts offers better chances of success for closure of chylous fistulae in the neck, especially when the fistulous opening was difficult to ligate and the site of leak was only packed with sponge gel or Surgicel®. This complication should be better avoided than repaired. How to cite this article Naik SM, Chavan P, Halkud R, Shenoy AM, Nanjundappa A, Gupta S. Crushed Muscle Tissue Graft: A Efficient Repair Technique for Intraoperative Chylous Fistulas. Int J Phonosurg Laryngol 2013;3(1):1-5.

Use of wound drains following open reduction and internal fixation of femoral shaft fractures

To determine if routine use of closed suction wound drainage is justified following open reduction and internal fixation of femoral-shaft fractures. Patients undergoing reduction and internal fixation of 75 femoral shaft fractures were prospectively randomised into two groups: one receiving closed-suction drainage (CSD) and one no wound drainage (NWD). The state of the wound dressing at 24 and 48 hours post-surgery, blood transfusion requirements, status of the wound (presence of hyperaemia, surgical site infection, undue wound tenderness, presence of induration at the wound edge and wound healing) at days 7, 14, 28 and 90 postoperatively, and duration of wound healing, were assessed. A total of 65 patients, with 75 femoral shaft fractures, completed the study: 37 fractures in CSD group and 38 in the NWD group. No significant difference was observed between the two groups in terms of the state of wound dressing at 24 hours (p=0.192) or 48 hours (p=0.365). There was no statistically significant difference in the incidence of wound infection (X2=3.339, df=2, p=0.188) or duration of wound healing (X2=3.168, df=1, p=0.075) between the two groups. However, more patients in the CSD group had blood transfusions than in the NWD group (21.6% vs 15.8%), although this was also not statistically significant (p=0.181). No benefit was observed in the routine use of wound drains following open reduction and internal There were no external sources of funding for this study. The authors have no additional conflicts of interest to declare.

Use and Outcomes of Wound Drain in Spinal Fusion for Adolescent Idiopathic Scoliosis

A multicenter retrospective analysis. To evaluate outcomes of closed-suction wound drainage after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis and to identify surgeon patterns of drain use in this cohort. There is little evidence on the use of drains in spinal surgery, particularly for repair of adolescent idiopathic scoliosis. Studies on hip and knee arthroplasty suggest no advantage to draining. There are few published reports on surgeon technique and rationale for drain use in spinal surgery. Patients were divided into drain and no drain cohorts and followed for 2 years. Primary outcome was complication rate. A separate survey was conducted from surgeons in the Spinal Deformity Study Group to evaluate drain practice patterns. There were 324 drained and 176 undrained patients. Complication rate did not differ between the drain and no drain cohorts in any of the 4 categories (wound infection, neural injury, other infection, and other complication) at any time (all P > 0.1). More drained patients received postoperative transfusions compared with those without a drain (43% vs. 22%, P < 0.001). Of the 50 surgeons in the group, 36 used drains. Half of these did so out of habit. Surgeons tended to place deep drains with bulb suction, without drain manipulation. Half removed drains on the basis of output, whereas half removed them after 1 to 3 days. More patients tended to receive wound drains than not receive wound drains. Drains did not impact complication rate and drained patients received more blood product. There are no universal criteria for draining and practice patterns vary widely.

Closed Wound Suction Drainage Following Anterior Cervical Discectomy and Fusion

Closed Wound Suction Drainage Following Anterior Cervical Discectomy and Fusion

Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients

Complete dural closure is not always possible following posterior fossa surgery, often requiring a graft to secure complete closure. The authors report their experience of using a collagen matrix as an onlay dural graft for repair of a posterior fossa dural defect. A retrospective analysis was performed in 52 adult patients who had undergone collagen matrix duraplasty for the posterior fossa. Complications directly related to the dural graft, the presence or absence of hydrocephalus, and the role of closed suction wound drainage in relation to postsurgical pseudomeningoceles were analyzed. The indication for posterior fossa surgery was tumors in 32 patients, vascular abnormalities in 9 patients, and spontaneous cerebellar hemorrhage in 11 patients. Closed suction wound drainage was used in 23 patients (44.2%). Forty-eight (92.3%) of 52 patients had a dural defect > 2 cm. Nine (81.8%) of 11 patients with hydrocephalus required ventriculoperitoneal shunts. Complications of the surgery included pseudomeningoceles in 2 patients (3.8%; no closed suction wound drainage); superficial wound infections in 1 patient (1.9%; with closed suction wound drainage); and unexplained eosinophilia in 1 patient. Duraplasty using a collagen matrix is safe and effective in the posterior fossa, and is easy to use and time efficient. Meticulous layered wound closure, the detection and effective control of hydrocephalus, and the use of closed suction wound drainage reduces complications related to collagen matrix duraplasty for the posterior fossa.

Complication Rate of Retrosigmoid Craniotomy with and without Closed-Suction Wound Drainage

Complication Rate of Retrosigmoid Craniotomy with and without Closed-Suction Wound Drainage

High-pressure gradients generated by closed-suction surgical drainage systems.

Closed suction drains remain in widespread use in surgical practice. There have been reports of complications associated with their use. We sought to characterize the pressure-generating capacities of three commonly used closed suction drainage systems. Three commonly used closed suction surgical drainage systems were studied: Davol Reliavac 400 Evacuator, Jackson-Pratt Closed Wound Suction Drainage System, and Snyder Hemovac 400. Each drainage system was connected to a pneumatic pressure transducer, and pressure measurements were made. Measurements were made with the drain reservoirs at varying degrees of fullness. Measurements were also made while "stripping" the drains. In all three systems, maximal negative pressures (-71 to -175 mm Hg) were generated with the reservoirs empty of fluid. Pressure generation by all drains decreased as the volume of fluid in the reservoir increased. In all cases, drain "stripping" was associated with a transient elevation in drain pressure (p<0.05). In two out of three drains, stripping led to a significant residual increase in static drain pressure. Closed suction drains are capable of generating high pressures that may contribute to some complications associated with their use. Closed suction drainage systems differ with regard to their generation of negative pressure.

Comparative Study with Closed Suction Wound Drainage and Pouching for Patients with Fistula

Comparative Study with Closed Suction Wound Drainage and Pouching for Patients with Fistula

Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients.

We reviewed the results of acute management of patients who had sustained a dural tear during an operation on the lumbar spine, and we attempted to determine the long-term sequelae of this complication. In the five years from July 1989 to July 1994, 641 consecutive patients had a decompression of the lumbar spine, performed by the senior one of us; of these patients, eighty-eight (14 percent) sustained a dural tear, which was repaired during the operation. The duration of follow-up ranged from two to eight years (average, 4.3 years). Postoperative management consisted of closed suction wound drainage for an average of 2.1 days and bed rest for an average of 2.9 days. Of the eighty-eight procedures that resulted in a dural tear, forty-five were revisions; these revisions were performed after an average of 2.2 previous operations on the lumbar spine, all of which resulted in a scar adherent to the dura. Only eight patients had headaches related to the spinal procedure and photophobia in the postoperative period; these symptoms resolved in all but two patients, both of whom had had a revision operation. Each of the two patients had symptoms of a persistent leak of spinal fluid and needed a reoperation for repair. Overall, seventy-six patients had a good or excellent result and twelve had a poor or satisfactory result with some residual back pain. One patient had arachnoiditis, and another had symptoms of viral meningitis one month postoperatively. A dural tear that occurs during an operation on the lumbar spine can be treated successfully with primary repair followed by bed rest. Such a tear does not appear to have any long-term deleterious effects or to increase the risk of postoperative infection, neural damage, or arachnoiditis. Closed suction wound drainage does not seem to aggravate the leak and can be used safely in the presence of a dural repair.

Modified Closed Suction Wound Drainage Technique and Effects

Modified Closed Suction Wound Drainage Technique and Effects

Efficacy of Closed Wound Suction Drainage After Single-Level Lumbar Laminectomy

The use of closed suction drainage after spinal surgery remains controversial. The purpose of this study was to determine the indications for closed suction drainage after single-level lumbar surgery. Two hundred patients who were scheduled to undergo single-level lumbar surgery without fusion were prospectively randomized into two groups. One group had a closed wound suction drain placed deep to the lumbodorsal fascia before routine closure, whereas the second group had no drain placed. Hemostasis was achieved in all patients before the surgeon had knowledge of the randomization outcome. All drains were removed on the 2nd postoperative day, and the amount of drainage was recorded. After surgery, the patients were evaluated for signs and symptoms of continued wound drainage, hematoma/seroma formation, and/or infection as well as evidence of an acquired neurologic deficit. One hundred three patients had a drain placed before closure and two patients developed postoperative wound infection, both of which were successfully treated with orally administered antibiotics. Of the 97 patients who had no drain placed after the surgical procedure, one patient developed a postoperative wound infection that was treated with surgical incision and drainage, as well as intravenously administered antibiotics. Statistical analysis revealed that the presence or absence of a drain did not affect the postoperative infection rate. No new neurologic deficits occurred in any postoperative patient. The use of drains in single-level lumbar laminectomy without fusion did not affect patient outcome. There was no significant difference in the rate of infection or wound healing and no patient developed a postoperative neurologic deficit.

Evaluation of closed-suction drainage for treating auricular hematomas.

The principal and dynamics of closed-suction wound drainage lend themselves to use on auricular hematomas. This type of drainage was evaluated in the treatment of 10 auricular hematomas on nine animals. Seven animal owners rated the results of the procedure as "good," and two rated them as "fair." The two rating the procedure as having "fair" results owned dogs with allergic dermatitis, and the auricular hematomas recurred. In both dogs, auricular hematomas again recurred after other means of treatment were used. If the pocket for the vacuum tube is not secure and the animal is quite active, or if it molests the bandage, or both, it is possible for the tube to break or the needle to come off of the tubing.

Quantitative bacteriology of closed‐suction wound drainage in contaminated surgery

This study was designed to evaluate the predictive value of quantitative bacteriology of closed-suction postoperative wound drainage in identifying the patient likely to develop wound infection as well as its subsequent flora. Forty-one patients undergoing major cancer surgery of the head and neck were studied. Postoperatively, closed-suction wound drainage was cultured, and anaerobic and aerobic bacterial isolates were quantitated. The wound infection rate was 20% (8/41). No trend toward increased rate of wound infection with increased numbers of bacteria colonizing the wound was observed. Additionally, there was no consistent correlation between species of bacteria isolated from closed-suction wound drainage and recovery from subsequent wound infection. Quantitative bacteriology of closed-suction wound drainage after contaminated head and neck cancer surgery does not accurately predict which patients were likely to become infected, or the probable bacteriology of subsequent wound infection.

A comparative study of closed-wound suction drainage vs. no drainage in total hip arthroplasty

One hundred consecutive primary total hip arthroplasties performedby the same surgeon over 4 years were retrospectively reviewed. In the first 50, closed-suction drains were used; the following 50 were not drained. Comparison between the two groups revealed no statistically significant differences in wound problems, postoperative pyrexias, or other short-term complications. No wound infections occurred. A mean of 2.6 units of blood per patient was transfused to the nondrained group. In the drained group, a mean of 3.4 units of blood per patient was transfused. This difference was not statistically significant. The mean postoperative fall in haemoglobin concentration was 2.4 g/dl in the nondrained group, and 1.9 g/dl in the drained group. This difference was not statistically significant. This study demonstrated no advantage to the use of suction drains in uncomplicated total hip arthroplasty, and perhaps their routine use should be questioned.

The Use of Closed Wound Suction Drainage after Appendicectomy

The Use of Closed Wound Suction Drainage after Appendicectomy