Closed suction surgical wound drainage after orthopaedic surgery

Parker, Martyn J.; Roberts, C.P.

doi:10.1002/14651858.cd001825.pub2

Cited by 186 publications

(128 citation statements)

References 42 publications

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“…Although the use of barbed sutures provide advantages in terms of time and cost some studies found increased the frequency and severity of wound complications [112, 113, 115, 116]. The use of monofilament sutures are recommended because they are less susceptible to bacterial growth [114, 117]. …”

Section: The Operation Daymentioning

confidence: 99%

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The Prevention of Periprosthetic Joint Infections

Küçükdurmaz

Parvızı

2016

TOORTHJ

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Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

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Section: The Operation Daymentioning

confidence: 99%

“…The tips of the drains are showed to be contaminated in many studies from 41% to 54% [110, 111, 115, 116]. Theoretically, the contamination of drain tips may lead to infection, on the other hand, these results were not correlated with a subsequent PJI rates [117]. …”

Section: The Operation Daymentioning

confidence: 99%

The Prevention of Periprosthetic Joint Infections

Küçükdurmaz

Parvızı

2016

TOORTHJ

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“…However, there is insufficient evidence from randomized trials to support the routine use of closed suction drainage, when used alone, in orthopedic surgery. 2 Activated protein C (APC) is an anticoagulant with cytoprotective, anti-inflammatory and healing properties. 3 Human recombinant APC, marketed under the trade name Xigris (Eli Lilly, Indianapolis, IN), is currently indicated as an intravenous treatment in severe sepsis; however, we have recently shown its strong potential application in the healing of chronic wounds.…”

mentioning

confidence: 99%

Combination of Activated Protein C and Topical Negative Pressure Rapidly Regenerates Granulation Tissue Over Exposed Bone to Heal Recalcitrant Orthopedic Wounds

Wijewardena

Vandervord

Lajevardi

et al. 2011

The International Journal of Lower Extremity Wounds

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Chronic wounds arising from orthopedic surgery present a major clinical challenge. Osteomyelitis may develop from polymicrobial infection, which can be unresponsive to treatment and lead to amputation. Topical negative pressure (TNP) is an effective treatment in wound management and is now used worldwide. Activated protein C (APC) is an anticoagulant with cytoprotective and healing properties. The aim of this study was to determine whether combined treatment of TNP and APC was tolerated and was efficacious for treatment of difficult-to-treat wounds. Four patients who presented to Royal North Shore Hospital with wounds that were not responsive to conventional therapy were studied. All cases showed a marked reduction in wound size and depth within 1 week of starting treatment and progressively improved over time. There was a remarkable increase in the volume of granulation tissue. After treatment, wounds either completely closed or provided sufficient granulation tissue to allow split-thickness skin grafting. The treatment was well tolerated, and the patients were able to be managed on out-patient basis. Long-term follow-up suggested that this treatment prevented osteomyelitis. This innovative treatment is very promising and may significantly increase quality of care for patients with recalcitrant orthopedic wounds. A randomized, placebo-controlled double blind trial is required to further determine the efficacy of APC plus TNP.

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“…Therefore, avoiding the known risk factors is not a reliable strategy to prevent POSEH. Suction drainage can be expected to help obviate the complication in case of certain amount of intraoperative bleeding; however, a multitude of previous studies have shown that it is not a fail-safe way to prevent the catastrophic complication 3456789101112). There was only one prospective study that demonstrated the efficacy of suction drainage in reduction of remaining epidural hematoma 13).…”

Section: Discussionmentioning

confidence: 99%

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

Ahn¹,

Shin²,

Kim³

et al. 2016

Clin Orthop Surg

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BackgroundPostoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability.MethodsThis was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15.ResultsThe remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application.ConclusionsWith a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

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Closed suction surgical wound drainage after orthopaedic surgery

Cited by 186 publications

References 42 publications

The Prevention of Periprosthetic Joint Infections

The Prevention of Periprosthetic Joint Infections

Combination of Activated Protein C and Topical Negative Pressure Rapidly Regenerates Granulation Tissue Over Exposed Bone to Heal Recalcitrant Orthopedic Wounds

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

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