Securing of suction drains in head and neck surgery

A new adaptation for a secure surgical drain placement and a comparison with four common drain fixation methods

INTRODUCTION

The importance of postoperative drain fixation cannot be overemphasised. There are numerous described techniques for drain fixation. However, to our knowledge, there is no evidence-based comparison between the various techniques of drain fixation used in postoperative management. We describe a new method and compare its reliability with four other commonly used methods.

MATERIALS AND METHODS

Five methods were chosen for testing based on current trends in clinical practice: centurion sandal with plastic locking ties, centurion sandal or lattice method, centurion sandal with half-inch Steristrips®, double and multiple looped methods. We used an Instron 8872® tensiometer to apply a measured force to a secured drain. Each fixation method was tested ten times and all fixation methods were performed by the same experienced surgeon. We measured the average number of cycles before failure, the average displacement of the tube at failure and the time needed to apply each fixation method.

RESULTS

The number of cycles completed before failure showed that the centurion sandal method, the centurion sandal with plastic ties and the centurion sandal method with Steristrips had the lowest failure rate. The amount of displacement was the least in the centurion sandal with plastic ties followed by the double-loop method and centurion sandal with Steristrips. There was little difference in the time taken to complete the fixation methods (range 21-33 seconds).

DISCUSSION

We recommend the use of the centurion sandal with plastic locking ties, centurion sandal with Steristrips followed by the centurion sandal method alone as fixation techniques that are quick to perform, secure and reliable.

Complications associated with suction drains after microvascular anastomeses

Two head and neck cases in which free flaps were used for reconstruction are presented. The circulation of the flaps was compromised due to problems directly associated with suction drains. The methods of drain fixation are discussed.