Subcutaneous Drainage Research Articles

Impact of subcutaneous negative pressure drain for surgical wound healing in ovarian cancer

Impact of subcutaneous negative pressure drain for surgical wound healing in ovarian cancer

Impact of subcutaneous negative pressure drains on surgical wound healing in ovarian cancer

IntroductionSubcutaneous negative pressure wound drains have been used to reduce wound complication rates in various surgical procedures. However, research on the benefits of subcutaneous drains on wound healing after ovarian...

Effects of Subcutaneous Jackson-Pratt Drain on Incisional Surgical Site Infection after Open Colorectal Resection for Cancer: a Prospective, Randomized, Multicenter Clinical Study

Incisional surgical site infections (SSI) are an important problem in patients undergoing surgery. The aim of the present study is to compare the effects of Jackson Pratt (JP) drain placement in patients with and without drains on incisional SSI after colorectal resection for cancer. The trial was designed as a prospective, randomized, controlled multicenter study. Patients who underwent colorectal resection for cancer were included in the study. Patients were randomized to subcutaneous JP drain group or control group (ND). The primary outcome was the presence of SSI. A total of 182 patients (89 in the JP group and 93 in the ND group) were analyzed. There was no significant difference between the groups in terms of demographic and surgical characteristics. SSI developed in 5.6% of patients in the JP group and in 19.4% of those in the ND group (p 70 years of age were the identified risk factors for incisional SSI. This study showed that elderly and obese patients and those with thick subcutaneous fat tissue should be placed JP drains to prevent SSI in open colorectal resections for cancer.

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.

Early subcutaneous drainage of skin and soft tissue infections in patients with febrile neutropenia: A new treatment option

Patients with febrile neutropenia presenting a cutaneous portal of entry for an infectious agent are at high risk of death (19-32%). If medical management is well codified, surgical management represents a therapeutic dilemma because the only available option is an aggressive debridement of the infected area which is associated with a high morbidity rate. Our objective was to implement a low-risk technique that is quick to perform and does not delay major surgical debridement if the latter turns out to be necessary. We performed an early subcutaneous drainage of the infected areas by percutaneous approach in order to avoid the evolution towards skin and subcutaneous necrosis. Five consecutive patients were treated with this technique associated with the recommended medical treatment between March and September 2017. This technique is based on the mechanical concept of the evacuation of the edema from the inflammatory area which would allow a better efficiency of the antibiotic treatment thanks to a better blood perfusion and a higher tissue concentration of antibiotics. Of the 5 patients managed in the department, no skin necrosis occurred, no surgical debridement was necessary, and no patient died during the episode of febrile neutropenia. Early subcutaneous drainage by percutaneous approach of an area of skin infection in a patient with febrile neutropenia may be considered as an interesting option. This technique allows without loss of chance for the patient to increase survival and decrease the number of aggressive surgical debridement and their high morbidity.

Antimicrobial Resistance and Pathogenicity Determination of Community-Acquired Hypervirulent Klebsiella pneumoniae.

Hypervirulent Klebsiella pneumoniae (hvKp) can cause severe invasive infections in healthy and immunocompromised individuals. However, there is still lack of a consensus definition of hvKp. In this study, we solely focused on the clinical isolates cultured from subcutaneous drainage of community-acquired liver abscess cases, and an hvKp strain was defined on the basis of co-harboring virulence gene regulator of mucoid phenotype A (rmpA)/rmpA2, iucA, iroB, and peg-344. A total of 47 nonrepetitive hvKp isolates were collected from January 2015 to December 2017 in a tertiary teaching hospital in Shanghai, China. All isolates were susceptible to the commonly used antibiotics. Only one strain (RJ-Kp24) had the positive detection of blaCTX-M-14 and was resistant to ceftazidime, cefotaxime, and cefepime. S1-pulsed-field gel electrophoresis (PFGE) and southern hybridization confirmed the presence of a roughly 90 kb blaCTX-M-14-carrying plasmid and a roughly 240 kb virulence plasmid. Further analysis revealed that ST23 (n = 17) sequence type and K1 (n = 20) and K2 (n = 9) serotypes were dominant in hvKp, while only 31.9% (15/47) and 46.8% (22/47) of hvKp isolates displayed hypermucoviscosity and resistance to serum killing, respectively. For further evaluation of the pathogenicity of hvKp, six representative strains were randomly selected. Three strains, RJ-Kp10, RJ-Kp28, and RJ-Kp31, displayed a remarkable resistance to serum killing and neutrophil phagocytosis. Mouse lethality assay revealed that these strains had the 50% lethal dose (LD50) of 102-103 cell forming unit (CFU), while others had the LD50 of 104-105 CFU. These results demonstrated that strain virulence differed significantly within these defined hvKp. The convergence of multidrug resistance and enhanced virulence in K. pneumoniae has presented a major infection control challenge.

Postoperative Shock as Independent Factor for Incisional Surgical Site Infection in Left-Side Colorectal Perforation

The incidence of incisional surgical site infection (SSI) in patients with colorectal perforation is reported to be approximately 40%. Although these subcutaneous drains and wound protector are performed using a wound closure method aimed to prevent incisional SSI, the evidence for colorectal perforation is poor. Although delayed primary closure (DPC) is reported to be an effective method to maintain open wounds, its management is time-consuming and cannot be performed in all cases. Therefore, the closure method should be carefully selected based on the risk of SSI. This study aimed to evaluate the risk factors of incisional SSI in left-side colorectal perforation with stoma creation. A total of 130 patients who underwent emergency surgery for left-side colorectal perforation with stoma creation between 2007 and 2017 were retrospectively investigated. Univariable and multivariable analyses were used to identify risk factors for incisional SSI. The total number of patients with incisional SSI was 58 (45%). In the univariate analysis, postoperative shock, postoperative ventilator support, and base excess (< − 2.0) were correlated with higher risk of incisional SSI. Multivariate analysis showed that postoperative shock was an independent risk factor for incisional SSI (odds ratio, 2.60; 95% confidence interval, 1.06–6.37). Postoperative shock is the risk factor of incisional SSI in left-side colorectal perforation with stoma. DPC should be considered in case of colorectal perforation combined with shock.

Characteristics of Subcutaneous Drainage Fluid in Patients After Hepatopancreatobiliary Surgery

The beneficial effect of subcutaneous drainage has been challenged. Here, we evaluated subcutaneous drainage fluid characteristics in patients without complications after hepatopancreatobiliary surgery. We aimed to provide useful information for addressing this issue. We included 59 patients that underwent hepatopancreatobiliary surgery for hepatic (n = 33), biliary (n = 12), and pancreatic (n = 14) disorders. We recorded the total volume of drainage liquid. We analyzed drainage fluid characteristics (biochemical test, cells, etc.) and patient demographic and clinical characteristics. Differences in characteristics were assessed among hepatic, biliary, and pancreatic surgery groups. Pearson correlation coefficient analyses were performed to assess associations between preoperative parameters and drainage volume. The median body mass index was 24.01 kg/m2. The mean blood loss and operation time were 371 ml and 406 min, respectively. Three (5.1%) patients required transfusions. The median drainage fluid volume was 37.34 ml, and the median density was 1.0217. The total numbers of white and red blood cells were 4.38*105/L and 30.5*103/L, respectively. The protein, glucose, and adenosine deaminase contents were 34.41 g/L, 1.22 mmol/L, and 103.09 U/L, respectively. The Rivalta test and lactate dehydrogenase were positive in 14 (77.8%) and 16 (88.9%) patients, respectively. All parameters were similar between the three surgical groups. Preoperative erythrocyte and hemoglobin levels were weakly positively correlated with subcutaneous drainage fluid volumes. We found a substantial amount of protein in subcutaneous drainage fluid. Removing the fluid might reduce the risks of incision fat liquefaction and infection. At minimum, subcutaneous drainage reduced the frequency of incisional dressing changes.

Minimizing CSF Leak and Wound Complications in Tethered Cord Surgery with Prone Positioning: Outcomes in 350 Patients

We document the results of a protocol to reduce the incidence of cerebrospinal fluid (CSF) leak and other wound complications in patients undergoing tethered cord surgery (TCS). Data from all patients undergoing TCS between January 2009 and April 2019 were reviewed retrospectively. Diagnosis (high risk or low risk; based on the presence of fascial and dural defects at surgery), type of graft used for dural or fascial repair, and CSF leak and other wound complications in the postoperative period were noted. All patients were nursed in the prone position with elevation of the foot end of the bed (Trendelenburg position) for at least 5 days after surgery with a subfascial drain in place. Of a total of 350 patients (191 high risk; 159 low risk), CSF leak from the wound was noted in 16 (4.5%). All but 4 of these patients were managed with wound suturing with or without insertion of a subcutaneous drain with continued nursing in the prone and Trendelenburg position. Two patients had meningitis and 3 patients had wound infection. Multivariate analysis revealed that the use of synthetic grafts (P < 0.000) and inability to close the dura (P= 0.02) were the only significant risk factors for CSF wound leak. Wound infections and/or dehiscence were noted in 17 (4.8%) other patients. Postoperative prone nursing with Trendelenburg position minimizes the incidence of CSF leak and other wound complications.

Evaluation of short-term loop colostomy in dogs using conventional and supporting subcutaneous silicone drain techniques.

Objective:This study aimed at evaluating the supporting and non-supporting loop colostomy techniques in dogs.Materials and Methods:In this study, 12 adult healthy mongrel dogs were used to carry out a short-term (21 days) temporary flank loop colostomy. The dogs were divided into two groups (n = 6). In the first group (Con group), conventional stoma fixation was operated without loop support. In the second group [subcutaneous silicone drain (SSD) group], an SSD was used as a supporting bridge. The stoma was fixed by a modified, interrupted seromuscular vertical mattress suture pattern. Both peristomal and stomal complications were recorded.Results:Results showed that a total of seven dogs (58%) suffered complications. There was a significant tendency toward less peristomal (p = 0.012) and stomal complications (p = 0.001) in the SSD group. The intensity of pain was significantly (p < 0.05) different between the two groups in the first week post surgery. Comfort with stoma care was significantly (p = 0.015) better in the SSD group, experiencing the best results.Conclusion:It is concluded that an appropriate stoma location, using a soft supporting bridge, stoma fixation using modified interrupted neuromuscular vertical mattress sutures, and proper appliance fixation by adhesive tapes and a tight T-shirt may overcome the complications of short-term loop colostomy in dogs and introduce a satisfaction for stoma care.

Abandoning the blind legacy passed on horde of routine intra-abdominal drain insertion in cesarean section.

IntroductionCesarean section (CS) delivery is the most common major obstetrical surgical operation carried out in and is increasing in incidence throughout the world. The major involves some risks that might include: infection, coagulation problem, loss of blood, bowel or bladder injury, abnormalities of the placenta in subsequent pregnancies.Aim of the studyTo evaluate the clinical effectiveness of postoperative CS intra-abdominal drain insertion.Material and methodsA prospective study was conducted on 245 patients in labor, at the Department of Obstetrics and Gynecology, Jordan University Hospital, between January 2017 and January 2018. Participants were divided into two groups: group I including those who had abdominal drains insertion during surgery and group II including women who had no abdominal drain inserted before closure. All patients on both groups were term pregnancies, underwent elective vs. emergency CS, and had no subcutaneous drains inserted.ResultsClinical and surgical parameters were comparable in both groups. Postoperative hospital stay was significantly shorter in group II, whereas specific postoperative complication rate was significantly higher in group I. Drain site infection was noted in 2 (1.6%), organ herniation in 2 (1.6%), drain avulsion in 2 (1.6%), severe pain at the site of insertion in 2 (1.6%) patients.ConclusionsRoutine prophylactic intra-abdominal drain insertion post CS has no benefits and therefore should be stopped.

Meta-analysis and single-center experience on the protective effect of negative suction drains on wound healing after stoma reversal.

Compromised wound healing following stoma reversal is a frequent problem. The use of negative suction drainage for reduction of complications remains controversial. The patient database of our center was reviewed for patients with ileostomy reversal between 2007 and 2017. Risk factors for wound complications were analyzed using multivariate regression analysis. Systematic review and meta-analysis was performed. Ultimately, results of this study were integrated into meta-analysis to assess the effect of drainage placement on wound healing. In our institutional analysis, a total of 406 patients with ileostomy reversal were included (n = 240 (59.1%) with drainage vs. n = 166 (40.8%) without drainage). In multivariate analysis, body mass index (BMI) was a risk factor for wound complications (odds ratio (95% CI) 1.06 (1.02-1.12)). Patients with drainage needed significantly fewer interventions than those without drainage (17.1% vs. 28.9%, p = 0.005). Placement of drainage significantly reduced the risk of wound complications even in the group with elevated BMI (odds ratio (95% CI) 0.462 (0.28-0.76), p = 0.003). Meta-analysis identified 6 studies with a total of 1180 patients eligible for further analysis (2 prospectively randomized trials; 4 retrospective cohort studies). Overall analysis revealed a significantly beneficial effect of wound drainage following ileostomy reversal (RR (95% CI) 0.47 (0.34, 0.66); p < 0.0001). In our institutional analysis as well as meta-analysis, the use of subcutaneous suction drains was beneficial for prevention of wound healing complications following ostomy reversal. Drainage placement is especially valuable in high-risk situations such as in obese patients.

Comparative Study Between Subcutaneous Tissue Closure Versus Drain in Obese Women Undergo Elective Cesarean Section

Comparative Study Between Subcutaneous Tissue Closure Versus Drain in Obese Women Undergo Elective Cesarean Section

Negative-pressure sternal wound closure with interrupted subcuticular suturing and a subcutaneous drain tube reduces the incidence of poststernotomy wound infection after coronary artery bypass grafting surgery.

To retrospectively evaluate the effect of negative-pressure sternal wound closure (NPSWC) with a subcutaneous closed drain tube on the sternal surgical site infection (SSI) incidence. After propensity score matching of 231 patients undergoing coronary artery bypass grafting (CABG), we compared 104 pairs in the NPSWC and historical control groups. In the molecular analysis, the interleukin-6 (IL-6), basic fibroblast growth factor (b-FGF), and transforming growth factor β1 (TGF-β1) levels in the wound fluid were measured using two different reservoir types at postoperative days 2 and 7. NPSWC significantly reduced the SSI incidence from 10.6 to 2.9%. No mediastinitis occurred in the NPSWC group. A multivariate logistic regression analysis identified female sex (p = 0.0040) and no NPSWC (p = 0.0084) as significant risk factors for sternal SSI development. The Negative-pressure value was 49.4 ± 4.1 and 115.5 ± 15.2mmHg in the standard-type (SSR) and bulb-type suction reservoirs (BSR), respectively. Given that growth factors were affected by the difference in negative pressure, the IL-6, b-FGF, and TGF-β1 levels were significantly higher in the BSR than in the SSR. NPSWC using a subcutaneous closed drain tube was effective in preventing sternal SSI after CABG and may accelerate wound healing even when both internal thoracic arteries are harvested. University Hospital Medical Information Network Clinical Trials Registry, registration number: UMIN000037060.

Subcutaneous suction drains do not prevent surgical site infections in clean-contaminated abdominal surgery-results of a systematic review and meta-analysis.

The role of subcutaneous prophylactic drainage in preventing postoperative abdominal wound complications is still controversial. We aimed to elucidate whether any difference in the incidence of surgical site infection (SSI) exists between patients with or without subcutaneous suction drain following clean-contaminated abdominal surgery. PubMed, EMBASE, and the CENTRAL were systematically searched for randomized controlled trials (RCT) comparing drained with undrained surgeries featuring gastrointestinal (GI) tract opening. The aim of the analysis was to assess the incidence of wound infection. A meta-analysis of relevant studies was performed using RevMan 5.3. A total of 8 studies, including 2833 patients, were considered eligible to collect data necessary. Globally, 187 patients (83 drained versus 104 undrained) experienced some SSI during the postoperative period. The use of subcutaneous suction drains did not exhibit any significant differences between drained and undrained patients in developing SSI (odds ratio 0.76, 95% CI 0.56-1.02; p = 0.07). According to the available, high-level evidence, the use of subcutaneous drains should not be encouraged on a routine basis, as it does not confer any advantage in preventing postoperative wound infection following clean-contaminated abdominal surgery. However, this does not exclude that there might be a benefit in a specific risk group of patients.

A prospective randomized trial examining the use of a closed suction drain shows no influence on strength or function in primary total knee arthroplasty.

The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps strength and to examine the effects of drain use on secondary outcomes: quadriceps activation, intra-articular effusion, bioelectrical measure of swelling, range of movement (ROM), pain, and wound healing complications. A total of 29 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were enrolled in a prospective, randomized blinded study. Patients were randomized to receive a CSD in one limb while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction ('sham drain'). Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps activation, intra-articular effusion measured via ultrasound, lower limb swelling measured with bioelectrical impendence and limb girth, knee ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day two, two and six weeks, and three months. Differences between limbs were determined using paired Student's t-tests or Wilcoxon's signed-rank tests. No significant differences were identified between limbs prior to surgery for the primary or secondary outcomes. No significant differences in quadriceps strength were seen between CSD and SCDRN limbs at postoperative day two (p = 0.09), two weeks (primary endpoint) (p = 0.7), six weeks (p = 0.3), or three months (p = 0.5). The secondary outcome of knee extension ROM was significantly greater in the CSD limb compared with the SCDRN (p = 0.01) at two weeks following surgery, but this difference was absent at all other intervals. Secondary outcomes of quadriceps activation, intra-articular effusion, lower limb swelling, and pain were not found to differ significantly at any timepoint following surgery. The use of CSD during TKA did not influence quadriceps strength, quadriceps activation, intra-articular effusion, lower limb swelling, ROM, or pain. These results have limited drain use by the authors in primary uncomplicated TKA. Cite this article: Bone Joint J 2019;101-B (7 Supple C):84-90.

Effect of subcutaneous negative pressure drainage and absorbable suture on prevention of postoperative complications of cranioplasty

Objective To explore the therapeutic effect of subcutaneous negative pressure drainage and absorbable suture in preventing postoperative complications of cranioplasty. Methods The clinical data of 175 cases of skull defect admitted and treated in Department of Neurosurgeryof the Affiliated Hospital of Binzhou Medical University from January 2012 to February 2018 were retrospectively analyzed.According to the different intraoperative treatment methods, 97 cases were treated with thread suture to the galea aponeurotica combined with general drainage(the general drainage group), and 78 cases were treated with absorbable suture to the galea aponeurotica combined with negative pressure drainage(the negative pressure drainage group). The galea aponeurotica were sutured intermittently with both silk thread and absorbable suture, and the drainage tube was placed outside the metal titanium plate under the skin, and removed after 48-72 hours.The postoperative complications of the two groups were compared. Results The incidence rates of subcutaneous hemorrhage, knotting reaction, infection of incision in the negative pressure drainage group were 1.3%(1/78), 0.0%(0/78), and 0.0%(0/78), respectively, which were significantly lower than those in the average drainage group[11.3%(11/97), 20.6%(20/97), 7.2%(7/97)], the differences were statistically significant(χ2=6.85, 18.16, 4.13, all P<0.05). Conclusion The application of absorbable suture suturing galea aponeurotica and subcutaneous negative pressure drainage in skull repair can significantly reduce and prevent postoperative complications of cranioplasty. Key words: Negative-pressure wound therapy; Drainage; Skull defect; Cranioplasty; Postoperative complications

Role of subcutaneous drain in class III and class IV laparotomy wound

Background: Surgical site infections (SSI) are major problem in general surgery. Aim of this study is to know the role of subcutaneous conrrugated drain in class III and IV laparotomy wounds.Methods: Comparative study was done in 100 patients of emergency laparotomy in civil hospital, Gandhinagar from January 2014 to December 2016.Results: Incidence of surgical site infections were significantly lower (16%) in patients with subcutaneous drain, compared to 40% in patients without drain (p value 0.01).Conclusions: Corrugated subcutaneous drain is cost effective way of reducing surgical site infections and subsequent morbidities in class III and IV laparotomy wound.

Subcutaneous negative pressure versus simple closure of skin incision following an emergency laparotomy: a randomized control study

Background: Surgical site infection (SSI) is a major problem associated with open abdominal surgery and is related to increased morbidity, mortality and healthcare costs. A subcutaneous negative pressure drain reduces dead space in subcutaneous tissue by preventing accumulation of fluid. The aim of present study was to establish the efficacy of a subcutaneous negative pressure for preventing SSI following exploratory laparotomy.Methods: A total of eligible 76 patients who underwent emergency abdominal surgical procedure, between October 2016 to March 2018, were randomized into subcutaneous drainage (DG) and no drainage group (NDG). Antibiotic prophylaxis was applied to each patient. The diagnosis of superficial SSI was made and was graded according to Southampton Grading System.Results: 5 patients in drain group (40) and 25 patients in no drain group (36) had incisional SSI with statistical difference (p&lt;0.05). No statistical difference between groups was observed for age, sex, hospital stay (p&gt;0.05).Conclusions: Subcutaneous negative pressure prevents post-operative surgical site infection significantly. Subcutaneous negative pressure drainage reduces hospital stay in a patient undergone emergency laparotomy, compared to patients in whom negative pressure drain was not placed.

Subcutaneous reservoir drainage versus ventriculoperitoneal shunt for the treatment of posthaemorrhagic hydrocephalus in preterm infants

Subcutaneous reservoir drainage versus ventriculoperitoneal shunt for the treatment of posthaemorrhagic hydrocephalus in preterm infants