Passive Drains Research Articles

Evaluation of different modalities in prevention of seroma formation post-modified radical mastectomy – An observational study from a rural tertiary care center

Background: Seroma, a recognized complication of modified radical mastectomy (MRM) delays the administration of adjuvant therapy and also effects adverse events. Aims and Objectives: This study was conducted to study the sociodemographic and clinical profile of patients developing seroma post MRM and compare the effectiveness of different modalities of seroma prevention since there is a dearth of literature on this matter in our sub-Himalayan region. Materials and Methods: This was an observational study conducted from February 2021 to August 2022 on 60 women with carcinoma breast who underwent MRM. They were studied for sociodemographic profile, cancer characteristics, and seroma prevention techniques and followed up during the study period. Preventive modalities used were quilting, octreotide therapy, suction drains with early drain removal, passive low suction drains, sharp dissection technique, and sclerotherapy. The results were analyzed using the Statistical Package for the Social Sciences version 22. Results: The mean age was 49.7±9.4 years, 18.3% had hypertension and 10.0% diabetes mellitus, and 58.3% presented with breast lump. Overall incidence of seroma was 23.3%; the highest was observed in sclerotherapy (50%), and the lowest was in quilting (7.1%) (P=0.235). The presence of hypertension (P=0.026) and the non-administration of neoadjuvant chemotherapy (P=0.010) was significantly associated with developing seroma. Sharp dissection was associated with wound infection (33.3%), sclerotherapy with flap necrosis (50%), and quilting with shoulder stiffness (21.4%). Conclusion: The lowest incidence of seroma was in quilting and the highest in sclerotherapy. Adverse events such as wound infection, shoulder stiffness, and flap necrosis were the lowest among patients discharged with passive drains and highest in sclerotherapy.

Active Drainage versus Passive Drainage after Modified Radical Mastectomy in Patients with Breast Carcinoma: A Randomised Controlled Trial

Introduction: Postoperative seroma formation is a common complication following Modified Radical Mastectomy (MRM), with an incidence ranging from 15-60%. There is a hypothesis that the negative pressure created by the suction drain used in MRM opens the damaged capillaries, preventing them from spontaneously closing and thereby increasing postoperative secretions. Aim: To compare active suction drains with passive drains in MRM in terms of postoperative outcomes. Materials and Methods: A randomised controlled trial with two arms, consisting of 15 patients in each arm, was conducted from November 2018 to March 2020 at the Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital in New Delhi. Patients diagnosed with localised breast carcinoma and scheduled for MRM were invited to participate. Pregnant females, patients with metastatic disease, those lost to follow-up, recurrent breast cancer patients, and those taking anticoagulants and antiplatelet agents were excluded from the study. The outcomes measured were drain output and duration of hospital stay, and postoperative morbidity, including flap necrosis, surgical site infection, seroma, and volume of seroma aspiration. The data acquired was analysed using the Statistical Package for Social Sciences (SPSS) version 21.0. Quantitative variables were compared using the Independent t-test and Mann-Whitney test as appropriate. Nominal categorical data was compared using the Chi-square or Fisher’s-exact test as appropriate. Results: Drain output was higher in the active group than in the passive group, but there was no significant difference in the average daily drain output and the average total output (652 mL versus 540 mL), except for the first two postoperative days. There was no statistically significant difference between the two groups in terms of hospital stay (6.67 days and 6.27 days), duration of drains in situ (6.67 days and 6.27 days), flap necrosis (13.3% vs. 13.3%), seroma formation (26.67% vs. 20%), and surgical site infection (26.67% vs. 20%). Conclusion: The use of suction in drains during MRM surgery is not compulsory and can save costs in resourcepoor settings. However, larger sample size studies with multicentre participation should be undertaken before making any recommendations.

Vacuum Drains versus Passive Drains versus No Drains in Decompressive Craniectomies–A Randomized Controlled Trial on Subgaleal Drain Complication Rates (VADER Trial)

Subgaleal drains are generally deemed necessary for cranial surgeries including decompressive craniectomies (DCs) to avoid excessive postoperative subgaleal hematoma (SGH) formation. Many surgeries have moved away from routine prophylactic drainage but the role of subgaleal drainage in cranial surgeries has not been addressed. This was a randomized controlled trial at 2 centers. A total of 78 patients requiring DC were randomized in a 1:1:1 ratio into 3 groups: vacuum drains (VD), passive drains (PD), and no drains (ND). Complications studied were need for surgical revision, SGH amount, new remote hematomas, postcraniectomy hydrocephalus (PCH), functional outcomes, and mortality. Only 1 VD patient required surgical revision to evacuate SGH. There was no difference in SGH thickness and volume among the 3 drain types (P= 0.171 and P=0.320, respectively). Rate of new remote hematoma and PCH was not significantly different (P= 0.647 and P=0.083, respectively), but the ND group did not have any patient with PCH. In the subgroup analysis of 49 patients with traumatic brain injury, the SGH amount of the PD and ND group was significantly higher than that of the VD group. However, these higher amounts did not translate as a significant risk factor for poor functional outcome or mortality. VD may have better functional outcome and mortality. In terms of complication rates, VD, PD, and ND may be used safely in DC. A higher amount of SGH was not associated with poorer outcomes. Further studies are needed to clarify the advantage of VD regarding functional outcome and mortality, and if ND reduces PCH rates.

The Sojourn Drain Effects on Tissue Healing in Postoperative Patients in Abdominal Surgeries: A Correlation of Prophylactic Antibiotic Administration and Complications

Medical equipment, device or implant which removes the fluid or gas from a wound and/or human body cavity is known as Surgical Drains. These surgical drains are commonly used in abdominal surgery to minimize the post-operative complications like infection and hematoma. These are of various types, our research focuses on passive drains made of latex, polypropylene, or silastic rubber. Relatively the different drugs administered as a prophylaxis were also noted. The objective of this study was to have the relation between the occurrence of post-operative complications and their effects on healing of the tissues. Administered Antibiotic prophylaxis decreases the rate of surgical wound infection.

Non-inferiority of open passive drains vs. closed suction in pancreatic surgery outcomes. A prospective observational study

Non-inferiority of open passive drains vs. closed suction in pancreatic surgery outcomes. A prospective observational study

Non-inferiority of open passive drains compared with closed suction drains in pancreatic surgery outcomes: A prospective observational study

BackgroundPolicies concerning the management of operatively placed drains after pancreatic surgery are still under debate. Open passive drains and closed-suction drains are both used currently in clinical practice worldwide, but there are no reliable data regarding potential differences in the postoperative outcomes associated with each drain type. The aim of the present study was to compare open passive drains and closed-suction drains with regard to postoperative contamination of the drainage fluid and overall morbidity and mortality. MethodsThis study was a prospective, observational analysis of 320 consecutive, standard, partial resections (pancreaticoduodenectomy and distal pancreatectomy at a single institution from April 2016 to April 2017. Either open passive drains (n = 189, 51%) or closed-suction drains (n = 131) were used according to the operating surgeon's choice. Postoperative outcomes, including samples of drainage fluid collected on postoperative day V and sent for microbiologic analysis, were registered. ResultsThe open passive drain and closed-suction drain cohorts did not differ in terms of their clinical features, use of neoadjuvant chemotherapy or preoperative biliary drainage, fistula risk zone, and type of operative procedure. The overall rate of postoperative day V drainage fluid contamination (27.5% vs. 20.6%, P = .1) was similar between the groups. The same results were obtained for each specific procedure. The postoperative outcomes, namely, overall 30-day morbidity, postoperative pancreatic fistula, intra-abdominal fluid collections, percutaneous drainage, wound infections, reintervention, mean duration of hospital stay, and mortality did not differ between the 2 groups. Qualitative microbiologic analysis revealed that after pancreaticoduodenectomy, 61.5% of the bacteria contaminating the drainage fluid were attributable to human gut flora, while after distal pancreatectomy, 84.8% of the bacteria belonged to skin and mucous flora (P < .01), however, the spectrum of bacterial contamination did not significantly differ between the open passive drain and closed-suction drain cohorts. ConclusionThe use of open passive drains and closed-suction drains for major pancreatic resection does not significantly impact the postoperative outcome. The spectrum of drain contamination depends on the specific operative procedure rather than on the type of drain used.

Non-inferiority of open passive drains compared with closed suction drains in pancreatic surgery outcomes: A prospective observational study

Non-inferiority of open passive drains compared with closed suction drains in pancreatic surgery outcomes: A prospective observational study

The Use of Peritoneal Suction Drainage to Reduce Shoulder Pain Caused by Gynecological Laparoscopy.

To compare the outcomes of patients undergoing uncomplicated laparoscopic gynecologic procedures with and without drainage, and investigate the effects of drainage on postoperative shoulder pain, hospital stay and analgesic medications. In this randomized clinical trial, 92 patients undergoing uncomplicated laparoscopic gynecologic procedures at Pars Hospital, Tehran, Iran, between April 2012 and July 2014 entered the study. Patients were randomly divided into two groups: one group received a drain at the end of operation, whereas the second group didn't receive a drain. For patients closed with drainage, Hemovac plastic passive drains were inserted without negative pressure. Severity of the patients' postoperative shoulder pain was evaluated at rest using the 10-point visual analogue scale (VAS) at 12 h, 24 h, and 48 h after surgery. There was no difference between the two groups regarding age, weight, height, BMI, the cause of surgery and the blood loss during the surgery. At 12 h and 24 h after surgery, the shoulder pain was statistically lower in the group with drainage (P < 0.001 for both). There was no statistically significant difference between mean VAS scores of the case and control group at 48 hours post-surgery (P = 0.806). A significantly higher postoperative demand for analgesics was observed in the control group (P < 0.001). There was no statistically significant difference between two groups regarding the length of hospital stay. Our findings suggest that drainage may be useful to prevent postoperative shoulder pain among patients undergoing gynecological laparoscopic surgeries and decrease the need for pain medication. Further studies are recommended to assess the feasibility and cost effectiveness of using this method for reducing the postoperative shoulder pain.

Drainage of the pelvic cavity through retroperitoneal space during operations on the pelvic organs

Types of drains and drainage methods after abdominal operations are fundamental in the prevention and treatment of postoperative complications. History of surgery is firmly linked with the development of drainage. Passive drains are used for cavity drainage in most cases. The authors describe history of drains and drainage methods, as well as their advantages and disadvantages. This paper presents technical specifications developed by the authors and their method of drainage installation of the retroperitoneal pelvic cavity after operations on the pelvic organs. The results demonstrate efficiency of the developed method for draining pelvic cavity on the basis of studies of a large number of patients.

River corridor science: Hydrologic exchange and ecological consequences from bedforms to basins

Previously regarded as the passive drains of watersheds, over the past 50 years, rivers have progressively been recognized as being actively connected with off-channel environments. These connections prolong physical storage and enhance reactive processing to alter water chemistry and downstream transport of materials and energy. Here we propose river corridor science as a concept that integrates downstream transport with lateral and vertical exchange across interfaces. Thus, the river corridor, rather than the wetted river channel itself, is an increasingly common unit of study. Main channel exchange with recirculating marginal waters, hyporheic exchange, bank storage, and overbank flow onto floodplains are all included under a broad continuum of interactions known as “hydrologic exchange flows.” Hydrologists, geomorphologists, geochemists, and aquatic and terrestrial ecologists are cooperating in studies that reveal the dynamic interactions among hydrologic exchange flows and consequences for water quality improvement, modulation of river metabolism, habitat provision for vegetation, fish, and wildlife, and other valued ecosystem services. The need for better integration of science and management is keenly felt, from testing effectiveness of stream restoration and riparian buffers all the way to reevaluating the definition of the waters of the United States to clarify the regulatory authority under the Clean Water Act. A major challenge for scientists is linking the small-scale physical drivers with their larger-scale fluvial and geomorphic context and ecological consequences. Although the fine scales of field and laboratory studies are best suited to identifying the fundamental physical and biological processes, that understanding must be successfully linked to cumulative effects at watershed to regional and continental scales.

Frequency dependence and passive drains in fish-eye lenses

The Maxwell fish eye lens has previously been reported as being capable of the much sought after phenomenon of subwavelength imaging. The inclusion of a drain in this system is considered crucial to the imaging ability, although its role is the topic of much debate. This paper provides a numerical investigation into a practical implementation of a drain in such systems, and analyzes the strong frequency dependence of both the Maxwell fish eye lens and an alternative, the Mi\~nano lens. The imaging capability of these types of lens is questioned, and it is supported by simulations involving various configurations of drain arrays. Finally, a discussion of the near-field and evanescent wave contribution is given.

CAN MAXWELL'S FISH EYE LENS REALLY GIVE PERFECT IMAGING? PART II. THE CASE WITH PASSIVE DRAINS

We use both FEM (flnite element method) and FDTD (flnite difierence time domain method) to simulate the fleld distribution in Maxwell's flsh eye lens with one or more passive drains around the image point. We use the same Maxwell's flsh eye lens structure as the one used in recent microwave experiment (10): Maxwell's flsh eye lens bounded by PEC (perfect electric conductor) is inserted between two parallel PEC plates (as a waveguide structure). Our simulation results indicate that if one uses an active coaxial cable as the object and set an array of passive drains around the image region, what one obtains is not an image of the object but only multiple spots resembling the array of passive drains. The resolution of Maxwell's flsh eye is flnite even with such passive drains at the image locations. We also found that the subwavelength spot around the passive drain is due to the local fleld enhancement of the metal tip of the drain rather than the flsh eye medium or the ability of the drain in extracting waves.

Streambank dewatering for increased stability

AbstractStreambank erosion is often the dominant source of sediment leaving modified watersheds. Mass failure of high, steep banks is one of the most serious forms of streambank erosion. The risk of a given bank experiencing mass failure is a function of bank height, angle, and soil strength, which is governed by soil moisture. Two methods for bank dewatering were tested in adjacent sections of streambank bordering a deeply incised channel in northern Mississippi: a low‐cost pump system and subsurface horizontal drains. Pore water pressures (both positive and negative pressures, or matric suction) were continuously monitored for 2 years at the pumped site, at an adjacent untreated control section, and for 1 year at the site stabilized with horizontal drains. Resulting data were used to calculate a time series of the factor of safety using a computer model. Over the course of two wet seasons, average bank retreats for the control and pumped plots were 0·43 and 0·21 m, respectively. More limited monitoring revealed that the site with passive drains retreated about 0·23 m. At the pumped site pore water pressure was 3–4 kPa lower than at the control site during the most critical periods. Accordingly, computed factors of safety were above the failure threshold at the pumped site, but fell below unity at the control site on 11 occasions over the period of observation. Similarly, the drained site displayed generally lower pore water pressure and higher safety factors except for two events when drains were evidently overwhelmed with the volume of local surface and subsurface flows. These results suggest, but do not prove, that bank dewatering promoted lower rates of bank retreat and higher levels of stability since the three sites had slight differences in soils, geometry and boundary conditions. Initial cost of the dewatering treatments were significantly less than orthodox bank stabilization measures, but operation and maintenance requirements may be greater. Published in 2009 by John Wiley &amp; Sons, Ltd.

Passive versus active drainage following neck dissection: a non-randomised prospective study

Drainage is used following neck dissection to prevent the collection of fluid and aid healing. Active drains are thought to be more effective due to their ability to assist adherence of skin flaps and the minimisation of bacterial migration. There is controversy regarding the type of drain (active or passive) which should be used due to concerns about the potential for compromise of free flap pedicles with active drains. A prospective non-randomised study was undertaken to determine if there were any differences in neck healing following neck dissection between active and passive drains. A consecutive series of patients (the majority of whom had free flap reconstruction) were included over an 8 month period and were examined for delayed healing of the neck wound, flap loss, infection, haematoma and fistula. A total of 60 patients underwent 72 neck dissections during the study period (passive: 13, active: 47). The delayed healing rate in patients with passive drains was 54% compared with 6% for active drains (P < 0.001). This difference remained significant irrespective of surgeon grade, nodal status and whether or not a free flap was performed. There was no patient in whom the drain was thought to contribute to free flap loss. This non-randomised study has shown a significant difference in neck healing depending on the type of drain used following neck dissection. Despite the numerical differences between the groups the patients were relatively well matched for the parameters described. This difference in neck healing, combined with the lack of evidence for a contribution to flap loss, suggests active drains should be used following neck dissection in both free flap and non-free flap cases.

Contributions to Géotechnique 1948–2008: Groundwater

This paper reviews work on the subject of groundwater published in Géotechnique over the past 60 years. Contributions relating to the effects of groundwater on geotechnical structures, measurement of pore water pressure using piezometers, analysis of groundwater flow, ground-water control or construction dewatering, estimating hydraulic conductivity, and passive vertical drains are summarised and discussed. Three major areas of significant impact are identified: (a) the realisation of the dominant role of pore water pressure equilibration in the delayed failure of cut slopes; (b) determination of the hydraulic conductivity of soils by means of rising- or falling-head tests in piezometers and boreholes; and (c) understanding the role of soil fabric in groundwater control, and using it to extend the operational range of pumped groundwater control techniques to soils of low permeability.

Comparison of four-day and ten-day post-mastectomy passive drainage in Accra, Ghana

To determine the optimum period for passive post-mastectomy drainage in Accra, Ghana, comparing early (day 4) to late (day 10) drain removal. Randomised prospective clinical study. Surgical Department, Korle Bu Teaching Hospital, Accra, Ghana Patients with breast cancer scheduled for total mastectomy and level 11 axillary clearance. Patients were randomised to one of the two groups: early (day 4) and late (day 10) passive drainage. Duration of hospital stay, seroma formation and postoperative wound infection. Forty five patients had 4-day drainage and 42 had 10-day drainage. Late removal of drains (Day 10) was associated with a significantly higher drainage (1123ml) than those with early (4-day) drain removal (571 ml); p=0.0019. Late removal, however, had fewer seromas (28.6% vs. 46.7%; p=0.2), smaller aspirate volumes (435ml vs. 563ml) and fewer number of aspirations (2.1 vs. 3.2). Early removal had a shorter hospital stay of 6.2 (+/-1.52) days compared to 11.07 (+/- 0.76) days for late removal, and a lower wound infection rate (2.2% vs. 9.5%). There was a low incidence of seromas when drainage was <30 ml/day at the time of drain removal. Post-mastectomy passive drains may be removed when drainage is <30 ml in 24 hours. When there is a persistent large volume of axillary drainage, patients should be counselled about the relative risks of early and late drain removal. For patients who do not find seroma aspiration unacceptable, early (day 4) removal appears preferable to late (day 10) removal of drains.

Surgical Pearl: Use of the Vacutainer as a closed, active, surgical drain

J Am Acad Dermatol 2003;48:933-4.

Surgical wound drainage: a survey of practices among gynaecologists in the British Isles.

All 2836 members and fellows of the Royal College of Obstetricians and Gynaecologists were circulated with a questionnaire concerning their practices with regard to wound drainage. The overall response rate was 43%, although that from practitioners of consultant and senior registrar status was 67%. The use of wound drainage was consistent between surgeons of differing levels of experience and different subspecialty interests within gynaecology. At routine 'clean' operations the use of drains is limited; only 0.4% of gynaecologists drain the peritoneal cavity, 1% the pelvis, 4% the subcutaneous tissues, and 20% the rectus sheath routinely. At more specialist 'clean' procedures, however, greater use of drains is made; at suprapubic incontinence operations 51% of surgeons drain the retropubic space; at radical hysterectomy 55% drain the pelvis; and at radical vulvectomy 63% use drains in the groins, routinely. In all the above operations much greater use is made of active (83%) than passive drains (17%). With potentially contaminated wounds, however, 46% of gynaecologists use a passive drain.

Closed-suction versus Penrose drainage after cholecystectomy: A prospective, randomized evaluation

Closed-suction drainage was compared prospectively to open, passive drainage (Penrose drains) in 128 patients undergoing cholecystectomy. Patients were randomized at the time of operation to receive either closed-suction drains (Group I, 67 patients) or Penrose drains (Group II, 61 patients). The preoperative clinical parameters of the two groups were similar. The patients in Group I when compared with those in Group II had a shorter duration of drainage (3.3 days and 4.1 days, respectively, p < 0.01), a lesser volume of drainage in the first 48 hours postoperatively (78 ml and 132 ml, respectively, p < 0.001), a decreased incidence of fever on the night of operation (24 of 67 patients and 39 of 61 patients, respectively, p < 0.05) and on the first postoperative day (26 of 67 patients and 32 of 61 patients, respectively, p < 0.05), and a lower leukocyte count on the first postoperative day (12,000 cells/mm 3 and 14,100 cells/mm 3, respectively, 0.05 < p < 0.1). Patients in Group I tended to have a lower rate of wound infection (1 of 67 patients versus 5 of 61 patients in Group II, 0.05 < p < 0.1) and had a much lower incidence of drain site tenderness (8 of 67 patients in Group I versus 24 of 61 patients in Group II, p < 0.05). This study demonstrates the superiority of closed-suction drains over open, passive drains after cholecystectomy.