• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.112-117
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• 2013

Objective : We performed this study to investigate whether the use of closed-suction drainage following microvascular decompression (MVD) causes cerebrospinal fluid (CSF) leakage. Methods : Between 2004 and 2011, a total of 157 patients with neurovascular compression were treated with MVD. MVD was performed for hemifacial spasm in 150 (95.5%) cases and for trigeminal neuralgia in 7 (4.5%) cases. The mean age of the patients was $49.8{\pm}9.6$ years (range, 20-69). Dural substitutes were used in 44 (28.0%) patients. Ninety-two patients (58.6%) were underwent a 4-5 cm craniotomy using drainage (drainage group), and 65 (41.4%) did a small 2-2.5 cm retromastoid craniectomy without closed-suction drainage (no-drainage group). Results : Eleven (7.0%) patients experienced CSF leakage following MVD based on the criteria of this study; all of these patients were in the drainage group. In the unadjusted analyses, the incidence of CSF leakage was significantly related with the use of closed-suction drainage following MVD (12.0% in the drainage group vs. 0% in the no-drainage group, respectively; p=0.003; Fisher's exact test). Those who received dural substitutes and the elderly (cut-off value=60 years) exhibited a tendency to develop CSF leakage (p=0.075 and p=0.090, respectively; Fisher's exact test). In the multivariate analysis, only the use of closed-suction drainage was significantly and independently associated with the development of CSF leakage following MVD (odds ratio=9.900; 95% confidence interval, 1.418 to infinity; p=0.017). Conclusion : The use of closed-suction drainage following MVD appears to be related to the development of CSF leakage.

• Archives of Plastic Surgery
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• 제45권6호
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• pp.542-549
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• 2018

Background Despite the increasing popularity of prosthetic breast reconstruction, scant data exist on the microbiological profile of drainage fluid from closed-suction drains and the relationship thereof to surgical-site infections (SSIs) in breast reconstruction surgery. This study aimed to determine whether bacteria isolated from drainage fluid were associated with the development of SSIs, and whether the bacterial profile of drainage fluid could be a clinically useful predictor of SSIs. Methods We performed a retrospective chart review of 61 women who underwent tissue expander/implant or direct-to-implant reconstructions. Patient demographics and culture studies of drainage fluid from suction drains collected on postoperative day 7 were evaluated. Results Sixteen patients (26.23%) were culture-positive, and 45 patients (73.77%) were culture-negative. The most frequently isolated bacteria were coagulase-negative staphylococci, followed by Staphylococcus aureus. SSIs were diagnosed in seven patients and were mostly resolved by systemic antibiotics; however, the tissue expander or implant was explanted in two patients. Positive culture of drainage fluid from closed-suction drains was significantly associated with the development of SSIs (P<0.05). The positive predictive value was 37.50%, and the negative predictive value was 97.78%. Conclusions To our knowledge, this study is the first to demonstrate a significant association between the microbiological profile of drainage fluid from closed-suction drains and the development of SSIs in patients with prosthetic breast reconstructions. The high negative predictive value suggests that microbial testing of drainage fluid from closed-suction drains may have clinical utility. Further prospective studies with larger sample sizes are required to confirm our findings.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제40권4호
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• pp.169-172
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• 2014

Objectives: The purpose of this retrospective study was to compare the amount of postoperative drainage via closed suction drainage system after intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO). Materials and Methods: We planned a retrospective cohort study of 40 patients selected from a larger group who underwent orthognathic surgery from 2007 to 2013. Mean age (range) was 23.95 (16 to 35) years. Patients who underwent bilateral IVRO or SSRO were categorized into group I or group II, respectively, and each group consisted of 20 patients. Closed suction drainage system was inserted in mandibular osteotomy sites to decrease swelling and dead space, and records of drainage amount were collected. The data were compared and analyzed with independent t-test. Results: The closed suction drainage system was removed at 32 hours postoperatively, and the amount of drainage was recorded every 8 hours. In group I, the mean amount of drainage was 79.42 mL in total, with 31.20 mL, 19.90 mL, 13.90 mL, 9.47 mL, and 4.95 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. In group II, the mean total amount of drainage was 90.11 mL, with 30.25 mL, 25.75 mL, 19.70 mL, 8.50 mL, and 5.91 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. Total amount of drainage from group I was less than group II, but there was no statistically significant difference between the two groups (P=0.338). There was a significant difference in drainage between group I and group II only at 16 hours postoperatively (P=0.029). Conclusion: IVRO and SSRO have different osteotomy design and different extent of medullary exposure; however, our results reveal that there is no remarkable difference in postoperative drainage of blood and exudate.

• Journal of Chest Surgery
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• 제24권9호
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• pp.890-894
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• 1991

We have performed a prospective study to assess the efficacy of suction drainage in 45 patients with primary spontaneous pneumothorax and 15 patients with secondary spontaneous pneumothorax, treated by closed chest tube drainage with underwater seal during the period Jan. 1990 to Dec. 1990 at the Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. The patients were divided randomly into two groups, 28 cases receiving suction and the other 32 cases no suction. The success rate was 82.1% for the former and 87.5% for the latter with the overall success rate of 85.0% and there was no significant difference in success rate between the two groups According to the causes and the extent of pneumothorax, the difference between the success rates of the two groups was also not significant statistically. But according to the duration of air leakage, suction group under 2 days showed a high success rate[46.4%] and the same group with 3-4 days, a relatively low success rate[21.4%] compared with that of the former. We conclude that the suction treatment is somewhat valuable in shortening the tubing time in patients with small amounts of air leakage, but it doesn`t seem to increase the success rate in all patients.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.33-41
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• 2020

Background Closed-suction drains are widely used in expander-based breast reconstruction. These drains are typically removed using a volume-based criterion. The drainage volume affects the hospital stay length and the recovery time. However, few studies have analyzed the factors that influence drainage volume after expander-based breast reconstruction. Methods We retrospectively analyzed data regarding daily drainage from patients who underwent expander-based breast reconstruction between April 2014 and January 2018 (159 patients, 176 expanders). Patient and operative factors were analyzed regarding their influence on total drainage volume and drain placement duration using univariate and multivariate analyses and analysis of variance. Results The mean total drainage volume was 1,210.77±611.44 mL. Univariate analysis showed correlations between total drainage volume and age (B=19.825, P<0.001), body weight (B=17.758, P<0.001), body mass index (B=51.817, P<0.001), and specimen weight (B=1.590, P<0.001). Diabetes history (P<0.001), expander type (P<0.001), and the surgical instrument used (P<0.001) also strongly influenced total drainage. The acellular dermal matrix type used did not affect total drainage (P=0.626). In the multivariate analysis, age (B=11.907, P=0.004), specimen weight (B=0.927, P<0.001), and expander type (B=593.728, P<0.001) were significant predictors of total drainage. Conclusions Our findings suggest that the total drainage and the duration of drain placement needed after expander-based breast reconstruction can be predicted using preoperative and intraoperative data. Patient age, specimen weight, and expander type are important predictors of drainage volume. Older patients, heavier specimens, and use of the Mentor rather than the Allergan expander corresponded to a greater total drainage volume and a longer duration of drain placement.

• Archives of Plastic Surgery
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• 제44권1호
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• pp.42-47
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• 2017

Background Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition. Methods The records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0-1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study. Results Seven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage. Conclusions Based on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients.

• Archives of Plastic Surgery
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• 제33권1호
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• pp.131-134
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• 2006

The closed suction drain is commonly inserted after various surgical procedures. It has an important role to prevent possible hematoma or seroma that can cause postoperative wound problems. But there is still no consensus on managing the insertion site of suction drain after operation. Suture-tie fixation of drain to skin and classical Y shape gauze dressing is a usually accepted method, but it has many limitations. We introduce a new approach to the care for the insertion site of suction drain by using occlusive transparent film dressing, $IV3000^{(R)}$(Smith & Nephew, London, UK). By using transparent film, insertion site of drain can be easily checked without removal of dressing. Because it can reduce the tension of suture-tie fixation, it helps to prevent skin injury. Furthermore, occlusive film dressing can block air leakage from insertion site of drain, and the water-proof character of film allows patients to take a shower without dressing change. This new method is more convenient, more efficient, and less harmful to skin than classic one.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권2호
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• pp.202-207
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• 1995

Chylous fistula is a rare complication occurring after radical neck dissection. Previous reports on neck dissection described an incidence of about 1% to 2%. We report a case of chylous fistula that occurred after radical neck dissection for squamous cell carcinoma of left lower gingiva and mandible in a 52-year-old man. We successfully managed the fistula by the following conservative measures : bed rest with head elevation, continuation of closed suction drainage, and dietary management to decrease the rate of chyle formation.

• Journal of Chest Surgery
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• 제17권4호
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• pp.729-734
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• 1984

Bochdalek hernia is a type of congenital diaphragmatic defect in the posterolateral portion of the diaphragm. The defect is usually Lt. sided due to protective effect of liver on right. Sex distribution is male preponderance [2:1] and it is diagnosed during neonate, mostly first 24 hours, due to severe respiratory distress. We experienced a rare case of old aged female patient with congenital Bochdalek hernia on Rt. side which was found incidentally during treatment of spontaneous pneumothorax of Rt. side. 17 year old female patient was admitted to CS department for chest discomfort on right and mild dyspnea with duration of 20 days. Under the diagnosis of spontaneous pneumothorax, Rt. closed thoracostomy and underwater sealed drainage with continuous suction was applied. On follow-up chest x-ray, poorly defined hazy increased density with multiple air-fluid levels in Rt. lower lung field and Lt. subphrenic free air were noted. So, Barium enema was done under the impression of Rt. diaphragmatic hernia, and nearly entire colon proximal to sigmoid was demonstrated in the Rt. hemithorax. Operation was done-for surgical repair of defected diaphragm through Rt. posterolateral thoracotomy. Operative findings were as follows; 1.Hypoplastic Rt. lung, esp. RML & RLL. 2.Nearly entirely intestines were herniated. 3.Diaphragmatic defect was located on posterolateral portion of the diaphragm, about 10x3cm in size with blunt smooth margin. 4.A large bleb on apex of RUL of lung. Herniated intestines were repaired into abdominal cavity manually and defect of diaphragm was repaired with No. I black silk interrupted sutures directly, and bleb was resected. Postoperative courses were uneventful and the patient was discharged with good condition on POD 14th.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.621-626
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• 2013

Background Ever since lipoabdominoplasty was first developed to achieve better aesthetic outcomes and less morbidity, the rate of seroma formation, especially in obese patients, has disturbed plastic surgeons. The aim of this study was to evaluate the effect of fibrin sealant in the prevention of seroma formation after lipoabdominoplasty in obese patients. Methods Sixty patients with a body mass index (BMI) between 30 and 39.9 were assigned randomly to 1 of 2 groups (30 patients each). Group A underwent lipoabdominoplasty with fibrin glue, while group B underwent traditional lipoabdominoplasty; both had closed suction drainage applied to the abdomen. The patients' demographics and postoperative complications were recorded. Seroma was detected using abdominal ultrasound examinations at two postoperative periods: between postoperative days 10 and 12 and, between postoperative days 18 and 21. Results The age range was 31 to 55 years ($38.5{\pm}9.5$ years) in group A and 25 to 58 years ($37.8{\pm}9.1$ years) in group B, while the mean BMI was 31.4 to 39.9 $kg/m^2$ (32.6 $kg/m^2$) in group A and 32.7 to 37.4 $kg/m^2$ (31.5 $kg/m^2$) in group B. In group A, the patients had a complication rate of 10% in group A versus 43% in group B (P<0.05). The incidence of seroma formation was 3% in the fibrin glue group but 37% in the lipoabdominoplasty-alone group (P<0.05). Conclusions Lipoabdominoplasty with the use of autologous fibrin sealant is a very effective method that significantly reduces the rate of postoperative seroma.