1887

Surgical drains in wound management and reconstructive surgery

image of Surgical drains in wound management and reconstructive surgery
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Abstract

A drain is a conduit placed in the wound to remove fluid and air. This usually refers to surgical implants, typically Penrose drains or closed suction drains; however, an autogenous drain, the omentum, can be used in selective cases. An alternative method of providing wound drainage is to leave part of the wound open. This technique is effective in open peritoneal drainage and can also work well with severely contaminated or necrotic skin wounds. The chapter looks at Indications for drain usage; Types of drain; Drain placement; Postoperative and drain care; Drain removal; Complications; and Drains in specific surgeries. : Drainage of a flank abscess; Surgical management and drainage of a chronic mucocele. : Placement of a Penrose drain; Placement of an active suction drain

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Figures

Image of 5.1
5.1 Inappropriate use of Penrose drains in a severe dogbite wound. Open management of this wound with wet-to-dry dressings would have been more appropriate.
Image of 5.2
5.2 Seroma formation in a Boxer dog after resection of a thyroid carcinoma.
Image of 5.4
5.4 Penrose drains in place after debridement of a dog bite wound; and after resection of an interdigital foreign body. (a, © Alison L. Moores)
Image of 5.5
5.5 A tube drain with suction being applied with a syringe. Suction is applied to the drain at least every 6 hours. The tube is sealed when it is not being actively drained. (© P Neath)
Image of 5.7
5.7 Jackson–Pratt drain. Drain and collection chamber. Flat end with fenestrations. A Boxer dog with a Jackson–Pratt drain in place. The collection system is sutured to the flank, making the drain system portable. (c, © P Neath)
Image of 5.8
5.8 Redon drains with corrugated (top) and rigid (bottom) collection chambers. (© Alison L. Moores)
Image of 5.9
5.9 Vacuum syringe drain made from a 19-gauge butterfly catheter and a 20 ml syringe.
Image of 5.11
5.11 Closed suction drain exiting adjacent to a primary wound. The drain tubing is secured to the skin with a Chinese finger-trap suture.
Image of 5.12
5.12 Meshed skin graft to allow drainage from under a full-thickness skin graft.
Image of Right flank swelling.
Right flank swelling. Right flank swelling.
Image of MRI showing changes in the epaxial muscles ventral to L2 (arrowed).
MRI showing changes in the epaxial muscles ventral to L2 (arrowed). MRI showing changes in the epaxial muscles ventral to L2 (arrowed).
Image of Grass seed foreign body.
Grass seed foreign body. Grass seed foreign body.
Image of Abscess drainage and lavage.
Abscess drainage and lavage. Abscess drainage and lavage.
Image of Jackson–Pratt drain in place.
Jackson–Pratt drain in place. Jackson–Pratt drain in place.
Image of Submandibular swelling.
Submandibular swelling. Submandibular swelling.
Image of Opening of the mucocele after surgical excision of the mandibular and sublingual salivary glands.
Opening of the mucocele after surgical excision of the mandibular and sublingual salivary glands. Opening of the mucocele after surgical excision of the mandibular and sublingual salivary glands.
Image of Placement of a closed suction tube drain into the capsule of the mucocele.
Placement of a closed suction tube drain into the capsule of the mucocele. Placement of a closed suction tube drain into the capsule of the mucocele.
Image of Jackson–Pratt drain in place at the end of surgery.
Jackson–Pratt drain in place at the end of surgery. Jackson–Pratt drain in place at the end of surgery.
Image of The Penrose drain is placed into the wound and secured proximally by a skin suture that incorporates the drain.
The Penrose drain is placed into the wound and secured proximally by a skin suture that incorporates the drain. The Penrose drain is placed into the wound and secured proximally by a skin suture that incorporates the drain.
Image of Haemostats are used to make the skin taut so that a scalpel stab incision can be made.
Haemostats are used to make the skin taut so that a scalpel stab incision can be made. Haemostats are used to make the skin taut so that a scalpel stab incision can be made.
Image of Forceps pull the end of the drain through the exit hole.
Forceps pull the end of the drain through the exit hole. Forceps pull the end of the drain through the exit hole.
Image of The wound is closed, with the drain exiting ventral to the wound and secured at the exit hole.
The wound is closed, with the drain exiting ventral to the wound and secured at the exit hole. The wound is closed, with the drain exiting ventral to the wound and secured at the exit hole.
Image of A wound next to the anus, caused by resection of a mast cell tumour. The site is considered contaminated.
A wound next to the anus, caused by resection of a mast cell tumour. The site is considered contaminated. A wound next to the anus, caused by resection of a mast cell tumour. The site is considered contaminated.
Image of A closed suction drain is selected and measured.
A closed suction drain is selected and measured. A closed suction drain is selected and measured.
Image of The needle attachment to the drain is exited from the wound.
The needle attachment to the drain is exited from the wound. The needle attachment to the drain is exited from the wound.
Image of The wound is closed and the drain connected to the collection chamber after being secured to the skin with a Chinese finger-trap suture.
The wound is closed and the drain connected to the collection chamber after being secured to the skin with a Chinese finger-trap suture. The wound is closed and the drain connected to the collection chamber after being secured to the skin with a Chinese finger-trap suture.
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