A clinical audit on the effect of suction drainage on microvascular anastomosis

Closed-suction compared with Penrose drainage after free flap reconstruction in the head and neck

Microsurgical free flaps are common in head and neck reconstruction, and their techniques and outcomes have continuously improved during the past decades. However, there are variations in practice among surgeons between the use of closed-suction drainage systems and Penrose drains. The proponents of Penrose drains propose that the negative pressure generated by the closed-suction drainage system may harm the microvascular anastomosis. We know of no previous studies that have compared the two drains for microvascular free flap reconstruction, so our aim was to compare them in a single-centre, retrospective review of all patients who had microvascular free flap reconstruction of the head and neck region in our department between 1 November 2010 and 1 September 2017. During this period 84 patients had 87 free flap reconstructions in the head and neck, 43 of which had Penrose, and 44 closed-suction, drainage. We compared the number of complications between the groups including haematomas, seromas, wound infections, anastomostic thrombosis, anastomotic revision, and need for re-exploration. There were no significant differences between the groups, despite a trend toward fewer negative explorations in the closed-suction group. There were no differences in complications between suction and passive drainage systems after microvascular free flaps, which suggests that closed suction drainage could be safely used after free flap reconstruction in the head and neck.

Passive versus active drainage following neck dissection: a non-randomised prospective study

Drainage is used following neck dissection to prevent the collection of fluid and aid healing. Active drains are thought to be more effective due to their ability to assist adherence of skin flaps and the minimisation of bacterial migration. There is controversy regarding the type of drain (active or passive) which should be used due to concerns about the potential for compromise of free flap pedicles with active drains. A prospective non-randomised study was undertaken to determine if there were any differences in neck healing following neck dissection between active and passive drains. A consecutive series of patients (the majority of whom had free flap reconstruction) were included over an 8 month period and were examined for delayed healing of the neck wound, flap loss, infection, haematoma and fistula. A total of 60 patients underwent 72 neck dissections during the study period (passive: 13, active: 47). The delayed healing rate in patients with passive drains was 54% compared with 6% for active drains (P < 0.001). This difference remained significant irrespective of surgeon grade, nodal status and whether or not a free flap was performed. There was no patient in whom the drain was thought to contribute to free flap loss. This non-randomised study has shown a significant difference in neck healing depending on the type of drain used following neck dissection. Despite the numerical differences between the groups the patients were relatively well matched for the parameters described. This difference in neck healing, combined with the lack of evidence for a contribution to flap loss, suggests active drains should be used following neck dissection in both free flap and non-free flap cases.