Use and misuse of drains in surgical practice

Surgical drain use compromises patient defenses and increases the incidence of postoperative complications in clean wounds. Drains should be employed only when clearly indicated. Drain exit sites should be aseptically prepared and separate from the surgical incision. Drains should not be placed near anastomotic sites and major vessels, and should be protected from premature removal and postoperative environmental contamination. Drains should be removed when drainage diminishes or the effluent character changes. Drain application beneath skin grafts and for treatment of open fractures or osteomyelitis is controversial, but may be beneficial in selected cases.