TITLE:
Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital
AUTHORS:
Ikpeme A. Ikpeme, Ngim E. Ngim, Iniabasi U. Ilori, Enembe Oku, Anthony M. Udosen
KEYWORDS:
Wound Drain; No-Drain; Complications; Orthopaedics
JOURNAL NAME:
Surgical Science,
Vol.4 No.5,
May
7,
2013
ABSTRACT: Background: Surgical wound drainage is practiced routinely by many
orthopaedic surgeons despite studies that challenge the
practice. Among proponents, the advantages of drainage include prevention of
haematoma and/or seroma formation which potentially reduces the chances for
infection, prevention of wound swelling, prevention of compartment
syndrome and improvement of the local wound environment. Opponents argue that
prophylactic wound drainage confers no significant advantages, increases the
risk of infection and the need for blood transfusion with the attendant risks
of this therapy. Aim: To ascertain if prophylactic drainage of clean orthopaedic wounds confer any
significant advantages by evaluating wound and systemic factors in two treatment
groups. Patients and Methods: A prospective analysis of 62
patients was undergoing clean orthopaedic procedures. The patients were randomly assigned
to a “No drain” (study) group and a “drain” (control) group. Each group had 31
patients. Surgeons were blinded to the randomization process and the evaluation
of clinical outcomes. The parameters assessed included pain, superficial wound
infection, the need for post-operative transfusion, wound leakage, dressing
changes and the surgery-discharge interval. Data was analysed
using SPSS statistics version 20 (IBM Corp., New York). Results: There
were no significant differences in the demographic data. Femoral fractures were
the commonest indication for surgery (43.55%), and plate and screw osteosynthesis
was the commonest procedure (48.4% in the drain group and 67.7% in the no-drain
group). There was a significantly higher need for post-operative
transfusion in the drain group (22.6% against 0%) as well as a significantly
prolonged capillary refill time (2.39 + 0.56 secs versus 2.03 + 0.41 secs). Although
not statistically significant, there were four cases (12.8%) of superficial
wound infection in the drain group and 1 case (3.2%) in the no-drain group. Conclusion: Prophylactic
wound drainage confers no significant advantages over no drainage
and may contribute to increased treatment costs through an increased
post-operative transfusion requirements.