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Letter to Editor Plastic and Aesthetic Research

Progressive drain withdrawal without

suture removal: a technical note

Zaher Jandali , Charles Yuen Yung Loh , Athanassopoulos Thanassi 2
2
1
1 Department of Plastic, Aesthetic and Reconstructive surgery, Asklepios Klinik Wandsbek, Hamburg, Germany.
2 Ninewells Hospital Dundee, Scotland, UK.

Address for correspondence: Dr. Charles Yuen Yung Loh, Ninewells Hospital, Dundee, Scotland, UK. E-mail: Chloh_yy@hotmail.com

Sir,
Drains are traditionally used in a variety of surgical
procedures; [1,2] although there is limited evidence of
[3]
their usefulness. 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)
[5]
in a sealed environment. 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 Figure 1: Progressive drain removal without suture release. Gentle traction
example, we place two or three vacuum suction drains on the drain with the forceps in place permits withdrawal of drain
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 tied with multiple knots, and a simple dressing over the
than 30 mL/day. [1,2] If fluid production from the wound drain is used for wound closure.
exceeds 30 mL/day for 5 days and is serous in nature, we For drain withdrawal, the drain suture is soaked with
progressively remove the drain in 3 cm steps until removal disinfectant spray (Bode Cutasept F, Hamburg, Germany),
®
is complete. to facilitate passage of the drain. The vacuum is then
The present report describes a method of progressive released to prevent the drain from adhering to the
removal of an external drain without suture release. tissue. The forceps are positioned directly proximal
Specifically, we suture a loop through the skin and fix the to the securing suture and closed firmly. The drain is
drain by a double-loop through the first loop. One or two compressed and slid through the suture with gentle
additional loops can be added if necessary. The suture is 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
Access this article online materials.
Quick Response Code:
Website: We have used this technique to gradually extract drains
www.parjournal.net
during 7 years of high-volume plastic surgery [Figure 1].
Our patients have reported no discomfort or pain. The
DOI: technique is safe and useful in situations where gradual
10.4103/2347-9264.135564 drain withdrawal is advantageous, such as high-output
seromas, postflap harvests, and groin dissections. It

Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014 41