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Evidence-Based Value of Subcutaneous Surgical Wound Drainage: The Largest Systematic Review and Meta-Analysis

Kosins, Aaron M. M.D., M.B.A.; Scholz, Thomas M.D.; Cetinkaya, Mine B.S.; Evans, Gregory R. D. M.D.

Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3182958945
Reconstructive: Trunk: Original Articles
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Abstract

Background: The purpose of this study was to determine the evidenced-based value of prophylactic drainage of subcutaneous wounds in surgery.

Methods: An electronic search was performed. Articles comparing subcutaneous prophylactic drainage with no drainage were identified and classified by level of evidence. If sufficient randomized controlled trials were included, a meta-analysis was performed using the random-effects model. Fifty-two randomized controlled trials were included in the meta-analysis, and subgroups were determined by specific surgical procedures or characteristics (cesarean delivery, abdominal wound, breast reduction, breast biopsy, femoral wound, axillary lymph node dissection, hip and knee arthroplasty, obesity, and clean-contaminated wound). Studies were compared for the following endpoints: hematoma, wound healing issues, seroma, abscess, and infection.

Results: Fifty-two studies with a total of 6930 operations were identified as suitable for this analysis. There were 3495 operations in the drain group and 3435 in the no-drain group. Prophylactic subcutaneous drainage offered a statistically significant advantage only for (1) prevention of hematomas in breast biopsy procedures and (2) prevention of seromas in axillary node dissections. In all other procedures studied, drainage did not offer an advantage.

Conclusions: Many surgical operations can be performed safely without prophylactic drainage. Surgeons can consider omitting drains after cesarean section, breast reduction, abdominal wounds, femoral wounds, and hip and knee joint replacement. Furthermore, surgeons should consider not placing drains prophylactically in obese patients. However, drain placement following a surgical procedure is the surgeon’s choice and can be based on multiple factors beyond the type of procedure being performed or the patient’s body habitus.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Author Information

Orange, Calif.; and Durham, N.C.

From the Aesthetic and Plastic Surgery Institute, University of California, Irvine, and the Department of Statistical Sciences, Duke University.

The first two authors should be considered co–first authors.

Received for publication July 17, 2012; accepted February 28, 2013.

Disclosure: There is no financial interest or commercial association for any of the authors that might pose or create a conflict of interest with the information presented in this article. No external funding was received.

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Aaron M. Kosins, M.D., M.B.A., Aesthetic and Plastic Surgery Institute, University of California, Irvine, 200 S. Manchester Avenue, Suite 650, Orange, Calif. 92868–3298, akosins@uci.edu

©2013American Society of Plastic Surgeons