Utilization of closed suction drains (CSD) in the post-operative period is well described. The potential sequelae of hematomas and seromas are of concern for surgeon and patient. There is debate in the literature regarding the usage of CSD to prevent such collections. This is an area in plastic surgery where experience-based medicine can be challenged by evidence. After carefully reviewing the scientific literature, the authors found that areas of major concern for seromas/hematomas formation are: facial rhytidectomy, abdominoplasty, and breast reduction surgery.
Methods/Technique:
Study Selection:
A systematic review of the literature was performed using Medline, Embase, Pubmed and Cochrane databases to identify all published studies that evaluated the use of CSD after patients underwent rhytidectomy, abdominoplasty, and breast reduction. The last search was conducted in October 2011.The Mesh search terms used were: “abdominoplasty,” “rhytidectomy,” “facelift,” “breast reduction,” “drain(s),” and “closed suction.” The combination of the aforementioned search terms generated relevant articles. All abstracts, studies, and citations were thoroughly reviewed. Each study was independently evaluated by three reviewers for inclusion or exclusion from the systematic review, and the following data were extracted: first author, year of publication, demographics of study population, study design, and indications for surgery.
Inclusion and Exclusion Criteria:
Inclusion criteria included Level 1 and Level 2 studies and large retrospective reviews addressing the aforementioned issues. Case reports were excluded.
Survey:
A list of all domestic and international members of the American Society of Plastic Surgeons (ASPS) was compiled. A survey pertaining to multiple plastic surgery patient management issues was created. Subsequently, it was approved by the IRB at the University of Maryland and Shock Trauma Center. A link to the survey was distributed via email to the ASPS members inviting them to participate. Responses and data were collected over a 5 month period through SurveyMonkey.
Results/Complications:
A total of 590 articles published prior to October 2011 was identified. After elimination of duplicates and studies that did not meet the inclusion criteria, 83 articles remained. Eighteen articles were selected from the titles and abstracts after exclusion criteria were applied, and a full examination of the texts was performed. These 18 studies matched the selection criteria and were included in the analysis. There was 100% agreement between the three reviewers.
There was a 13% overall response rate to the aforementioned questionnaire. 5299 questionnaires were disseminated and 687 plastic surgeons responded. Of the 5299 questionnaires distributed, several hundred were returned to server as blocked email address, cancelled email address, or spam mail. Of all respondents, 28.4%, 28.4%, and 90.5% felt that placing CSD would decrease seroma formation in patients undergoing breast reduction, rhytidectomy, and abdominoplasty, respectively. Of all respondents, 94.3% placed drains in patients who have undergone procedures that are considered high risk. With regards to hematoma, 20.7%, 17.4%, and 22.7% of respondents felt that placing CSD would decrease hematoma formation in patients undergoing rhytidectomy, breast reduction, and abdominoplasty, respectively. Of all respondents, 54% placed drains in patients who have undergone procedures that are considered high risk.
Conclusion:
A critical review of the literature validated that CSD are not a useful tool to decrease hematoma in patients undergoing rhytidectomy, abdominoplasty, or breast reduction. There is a role of CSD to decrease seroma rates in rhytidectomy and abdominoplasty (if quilting sutures are not employed-abdominoplasty). There is no evidence to support the use CSD in breast reduction patients. Evidence based medicine elucidates the correct clinical scenarios which drains should be used. Our survey provides data on variable practice patterns of plastic surgeons and how it affects their clinical practices.