Plast Aesthet ResPlastic and Aesthetic Research2349-61502347-9264OAE Publishing Inc.10.4103/2347-9264.135564Letter to EditorProgressive drain withdrawal without suture removal: a technical
noteJandaliZaher1https://orcid.org/0000-0003-2646-0358Chloh_yy@hotmail.comLohCharles Yuen Yung2ThanassiAthanassopoulos21Department of Plastic, Aesthetic and Reconstructive surgery, Asklepios
Klinik Wandsbek, Hamburg, Germany.2Ninewells Hospital Dundee, Scotland, UK.Correspondence Address: Dr. Charles Yuen Yung Loh, Ninewells
Hospital, Dundee, Scotland, UK. E-mail:
Chloh_yy@hotmail.com201427620141412542014462014This is an open access article distributed under the terms of the
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(http://creativecommons.org/licenses/by-nc-sa/3.0/), which allows others to
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terms.
Sir,
Drains are traditionally used in a variety of surgical procedures;[1,2]
although there is limited evidence of their usefulness.[3] Drains are classified based on various characteristics: as
open or closed systems, as active versus passive, as prophylactic versus
therapeutic; or by composition (e.g., polyurethane, silicone, or rubber).[2,4]
Closed vacuum drains apply negative suction (60-80 kPa) in a sealed
environment.[5] Drains are often secured
using a single suture or adhesive tape to prevent inadvertent removal. Complications
from drains include pain, hemorrhage, drain entrapment, and retrograde bacterial
migration that can result in postoperative infections.[1,2]
We routinely use drains after flap reconstructions. For example, we place two or
three vacuum suction drains in the gluteal myocutaneous rotation flaps that are used
to cover sacral pressure sores. The drains are sutured for security and are
completely removed if drainage is less than 30 mL/day.[1,2] If fluid production
from the wound exceeds 30 mL/day for 5 days and is serous in nature, we
progressively remove the drain in 3 cm steps until removal is complete.
The present report describes a method of progressive removal of an external drain
without suture release. Specifically, we suture a loop through the skin and fix the
drain by a double-loop through the first loop. One or two additional loops can be
added if necessary. The suture is tied with multiple knots, and a simple dressing
over the drain is used for wound closure.
For drain withdrawal, the drain suture is soaked with disinfectant spray (Bode
Cutasept®F, Hamburg, Germany), to facilitate passage of the drain. The vacuum is
then released to prevent the drain from adhering to the tissue. The forceps are
positioned directly proximal to the securing suture and closed firmly. The drain is
compressed and slid through the suture with gentle traction. If toothed forceps are
used, the drain must be positioned proximal to the teeth to avoid tearing. This
technique is applicable to drains of various diameters and materials.
We have used this technique to gradually extract drains during seven years of
high-volume plastic surgery [Figure 1]. Our
patients have reported no discomfort or pain. The technique is safe and useful in
situations where gradual drain withdrawal is advantageous, such as high-output
seromas, postflap harvests, and groin dissections. It avoids the need for
re-suturing and permits healing from the wound base. This method requires a certain
level of training and caution when performing the retrieval. The drain’s
security must be checked after each withdrawal as it can loosen, resulting in
premature drain removal.
Progressive drain removal without suture release. Gentle traction on the
drain with the forceps in place permits withdrawal of drain
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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