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Surgical drainage.

S R Smith, O J Gilmore

    British Journal of Hospital Medicine
    |June 1, 1985
    PubMed
    Summary
    This summary is machine-generated.

    Surgical drain effectiveness hinges on tissue reaction to materials. Silicone rubber drains offer safe, effective wound healing, while open drainage systems pose infection risks and should be avoided.

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    Area of Science:

    • Surgical innovation and materials science
    • Clinical efficacy of medical devices
    • Wound healing and infection control

    Background:

    • The efficacy of surgical drains is primarily determined by the patient's tissue reaction to the drain's constituent material.
    • Despite the availability of modern materials for over two decades, rigorous clinical evaluation of their impact on drainage outcomes remains limited.
    • Historical context highlights the importance of material biocompatibility in early drain development.

    Purpose of the Study:

    • To evaluate the clinical evidence supporting the routine use of intraperitoneal drains in abdominal surgery.
    • To assess the comparative efficacy and safety of different drainage systems and materials.
    • To provide evidence-based recommendations for optimal surgical drain selection and application.

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    Main Methods:

    • Review of existing clinical evidence regarding the use of various surgical drain materials, including latex rubber and silicone rubber (Silastic).
    • Analysis of different drainage techniques: static symphonage, low-pressure suction, sump suction with bacterial air inlet filters, and closed suction drainage.
    • Evaluation of the risks associated with open versus closed drainage systems, particularly in the context of prostheses and infection.

    Main Results:

    • Limited evidence supports routine intraperitoneal drainage in abdominal surgery, especially with latex rubber, unless creating a specific tract (e.g., T-tube).
    • Silicone rubber (Silastic) tubes are identified as the preferred material due to favorable tissue reaction.
    • Closed suction drainage in the abdominal wall (parietes) is safe and effective for managing serosanguinous oozing and promoting wound healing.
    • High-pressure suction appears to be the most effective drainage system.
    • Open drainage systems are generally discouraged due to infection risks, particularly when prostheses are present.

    Conclusions:

    • The choice of drain material and system significantly impacts surgical outcomes, with silicone rubber and closed suction being favored.
    • Routine intraperitoneal drainage lacks strong evidence and should be approached cautiously, prioritizing infection prevention.
    • Surgeons should adhere to evidence-based practices, recalling that 'No drainage at all is better than the ignorant employment of it'.