NDS No Drain Surgery

NDS: No Drain Surgery – Why Postoperative Drains Should Not Be Left in Place

Plastic surgeons are often asked this question: “Doctor, will I have drains after the operation?”

A surgical drain (i.e. Jackson-Pratt drain) is a small tube (made of plastic or silicone) left in place at the operative site, which leaves the skin through a small orifice. The drain can be left in place for one to three days, depending on the case.

I usually used to answer this question with a “yes,” but today the answer is always “NO.”

Why have practices that were once standard changed over the years?

Here are five good reasons not to leave a postoperative drain in place:

  1. Because it hurts
    The tube left in place exerts suction, and as a result it tugs at the surrounding tissues. This causes pain for as long as the drain is in place, and patients often have just one bad memory of the procedure: the removal of the drains.
  2. Because rather than preventing bleeding, it causes bleeding
    The tube draws in the surrounding tissues, including blood vessels. Fragile vessels may not be bleeding at first, but when they are sucked into the Jackson-Pratt drain, they begin to bleed.
  3. Because it can cause lymphoceles
    A lymphocele is a pocket (also called a collection) of lymph. Lymph is a liquid that is physiologically present in the body and is formed in inflammatory regions in particular. As for blood vessels, the suction exerted by the drain stimulates the lymphatic vessels and, in a way, causes them to generate more lymph than would be the case without drainage.
  4. Because it increases the risk of infection
    When a drain is left in place, one end is outside the body and the other end is in contact with the surgical site. This means that the drain is a direct link to the surgical site for germs found on the skin, which is especially problematic when prosthetic implants are present.
  5. Because it isn’t needed
    With precise hemostasis (a check that there is no bleeding) and careful quilting suture (to close up dead spaces), the risks of bleeding and lymphoceles are controlled and there is no need to take an unnecessary risk by leaving a drain in place.

For all of these reasons, I have stopped leaving drains in place, and yet there are no more complications than before. I would even venture to say that not using drains implicitly requires more surgical rigor.

Complications are obviously still possible, as in any surgical procedure, but they are in no way prevented by the presence of a drain.

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