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Surgical Vacuum Drains: Types, Uses, and Complications
RAJARAMAN DURAI, MD, MRCS; PHILIP C.H. NG, MD, FRCS
SURGICAL VACUUM DRAINS www.aornjournal.org
USE OF DRAINS
Drains are used both prophylactically and therapeutically. The most common use is prophylactic after surgery to prevent the accumulation of uid (eg, blood, pus) or air. In any surgery in which a dead space (eg, a cavity) is created, the body has a natural tendency to ll this space with uid or air. Use of a prophylactic drain is not routinely recommended after clean surgical procedures,2,3
although some articles claim that use of drains results in seroma reduction,4,5 and results of research have shown that use of vacuum drains may not inuence the outcome after tissue expander use in breast surgery.6 Surgical drains commonly are used after procedures on the thyroid,2 breast,7 and axillary area as well as after abdominal procedures and joint replacements.8,9 Vacuum drains may be used to drain perirectal wounds,10 and
certain special vacuum drains (ie, endoluminal) are available to treat anastomotic leaks that may occur after intestinal resection and anastomosis.11,12
DRAIN INSERTION
Typically, when a drain is required, it is inserted at the end of a surgical procedure. Frequently, the drain is inserted through a separate hole a few centimeters from the main incision to decrease the risk of a postoperative wound infection. There are two methods to insert a vacuum-type drain. The rst method is used with drains that have a sharp trocar attached to the tube. The surgeon uses the trocar with some drains attached to pierce the skin from the inside of the wound at the desired site and pulls the attached tube out through the stab wound. The surgeon places the inner end of the tube at the required site and detaches the trocar. The surgeon may secure the drain to the skin with a stay-stitch. After the wound is closed, the scrub person connects the tube to the reservoir. Suction may be attached to the reservoir to facilitate wound drainage.
The second method for drain insertion is used when a trocar is not attached to the drainage tube. In this case, the surgeon uses a forceps to pierce
the abdominal wall from the inside of the wound and pushes the forceps through...