Use of prolonged closed suction drainage for synovial fluid-draining wounds around the ankle

When synovial fluid drains through a wound, cells necessary to form tissue required for healing are washed away. This results in failure of wound closure, often necessitating a pedicled or free flap reconstruction. We hypothesised that prolonged (>48 hours post surgery) closed suction drainage can reduce the fluid draining through the wound, enabling wound healing and eliminating the need for a pedicled or free flap reconstruction. We also aimed to determine whether prolonged application of closed suction drainage would increase postoperative infection.

A retrospective study was performed between August 2015 and December 2020. Patients with fluid-draining wounds around the ankle which had failed to respond to treatment with delayed closure and which required the use of prolonged closed suction drainage were included. Closed suction (Jackson-Pratt, JP) drainage was applied from the time of wound closure until the wound healed.

A total of 20 patients (12 male: eight female; mean age: 52 years; range: 21-74 years) were included in the study. The results showed the JP drain being kept for a mean of 14.1±1.8 (range: 9-16) postoperative days. Prolonged closed suction drainage helped achieve wound closure in 19 (95%) patients. Only one patient with Achilles tendon exposure underwent sural flap surgery. None of the patients developed an infection due to prolonged use of the JP drain. With regards to patient satisfaction, four (21%), 10 (53%), four (21%) and one (5%) patients were 'very satisfied', 'satisfied', 'fair' and 'dissatisfied', respectively, with the results of the treatment technique at follow-up (mean: 29.9; range: 12-72 months). The remaining patient was lost to follow-up.

Prolonged application of closed suction drainage made wound closure possible for synovial fluid-draining wounds, eliminating the need for a pedicled or free flap surgery, without increasing the rates of wound infection. This technique could be used as an adjunct to the local flap, negative pressure wound therapy or other reconstructive techniques at the time of revision surgery.