[Drainage in soft tissue surgery. What is "evidence based"?].

Area of Science:

• Surgical techniques
• Wound management
• Biomedical engineering

Background:

• Numerous surgical drainage systems exist, leading to varied clinical practices.
• A significant gap is observed between scientific evidence and routine surgical application of drainage systems.
• Debate continues regarding the necessity of drainage in all surgical procedures.

Purpose of the Study:

• To evaluate the efficacy and patient outcomes of different surgical drainage systems.
• To compare high-vacuum versus gravity drainage in soft tissue surgery.
• To assess the necessity of prophylactic drainage in specific surgical contexts.

Main Methods:

• Literature review and analysis of existing studies on surgical drainage systems.
• Comparison of open versus closed drainage modes, and gravity versus vacuum suction.
• Evaluation of drainage materials (PVC, silicone, polyurethane) and duration of use.

Main Results:

• Open drainage systems for uninfected wounds are considered obsolete.
• Gravity drainage demonstrates comparable efficacy to high-vacuum (Redon) drainage.
• High-vacuum suction can cause tissue damage and increased secretion, with more painful removal compared to gravity systems.
• Prophylactic drainage is unnecessary for uncomplicated thyroid surgery and hernia repair.
• Drainage for up to 72 hours does not increase infection rates.
• Routine microbiological examination of drainage tips is not recommended.

Conclusions:

• Gravity drainage systems are a viable and less invasive alternative to high-vacuum suction in soft tissue surgery.
• Clinical practice should align with evidence, avoiding obsolete drainage methods and unnecessary prophylactic drainage.
• Optimizing drainage strategies can improve patient comfort and surgical outcomes.