THE USE AND ABUSE OF SURGICAL WOUND DRAINS STEVE MEHLER, DVM, DACVS Chief Medical Officer Veterinarian Recommended Solutions
In this VETgirl webinar “The use and abuse of wound drains,” Dr. Steve Mehler, DVM, DACVS reviewed all you need to know about surgical wound drains.
KEY HIGHLIGHTS
Surgical drains of various types have been used, with the best intentions, in different operations for many years and it is controversial whether they achieve their intended purpose. There is very little scientific evidence in human and veterinary surgery that demonstrates an absolute benefit of surgical drains but many veterinarians, the author included, continue to use drains in surgery. This lack of definitive evidence has not helped to resolve most of the controversial issues surrounding the use of surgical drainage. 1 INDICATIONS FOR SURGICAL DRAINAGE Surgical drains are used in a wide variety of procedures and the intention should be to decompress or drain fluid from the area of surgery. The single most important indication for surgical drain placement is to control dead space. Fluid accumulation in a wound or body cavity can lead to failure of the incision or repair, provides a nutrient source for bacteria and rapid colonization of tissues, prevents the ability of neutrophils to migrate into an infected area, can be a source of discomfort, and delays wound healing. The ultimate form of wound drainage is open wound management; however, it may not be the most practical, safe, and cost effective in some cases. Drains are not indicated to remove infected, devitalized and contaminated tissue and in fact, cannot do so. Drain materials of all types are considered
a foreign body. Foreign body reaction in all tissues will decrease the amount of bacteria required to establish an infection and simultaneously induce regional tissue inflammation. This fact coincides with a contraindication of drain use in patients; drains should not be used in place of aggressive surgical debridement and lavage. Drains are to be used to control dead space and fluid accumulation in a wound or cavity after appropriate surgical management. Drains are also used in some cases as a diagnostic tool in order to assess local wound fluid production, record fluid volume and consistency, and perform cytology. The diagnostic utilization of drains is controversial because the presence of the drain alone will cause fluid production, inflammation to regional tissues, and failure of healing of the surgical site secondary to inflammation. Drains should never be placed directly under an incision as the inherent inflammation they induce may negatively impact incisional healing. Drains should never exit or be in contact with haired skin and all drains should be protected by a bandage at all times. 2 CHARACTERIZATION OF A DRAIN Drains can be characterized as open or closed. Open drains (corrugated and noncorrugated rubber, silicone, or plastic) ideally drain fluid on to a gauze pad or into a wound dressing, a
collection bag, or are left unprotected and exposed to the environment. They increase the risk of infection, especially when left exposed to the environment. Closed drains are formed by tubes draining into a bag or bottle helping to reduce the risk of infection. Drains can also be classified as active or passive. Active drains are maintained under suction (low or high pressure). The drain can be attached to a suction source. (continued)
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