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Optimal Management of Tethered Surgical Drains

A Cadaver Study

Laratta, Joseph L., MD; Lombardi, Joseph M., MD; Shillingford, Jamal N., MD; Grosso, Matthew J., MD; Lehman, Ronald A., MD; Lenke, Lawrence G., MD; Levine, William N., MD; Riew, K. Daniel, MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: February 15, 2019 - Volume 27 - Issue 4 - p 129–135
doi: 10.5435/JAAOS-D-17-00122
Research Article

Background: Tethered drains are a complication of drain usage and may result in unintentional retained broken drains, as well as anxiety and uncertainty for the surgeon and the patient. To date, no study has examined the optimal approach for management and removal of tethered drains.

Methods: The study design sought to identify suture size, mechanism of drain fixation (through versus around), points of constriction (one versus multiple) and the efficacy of weighted traction as potential sources of tethered drains by means of four study arms. (1) Arm one compared drains sutured through the tubing versus a tight closure of the surrounding fascia, which were then subjected to weighted suspension. (2) Arm two compared drains sutured into the fascia using eight each of 4–0, 2–0 and 0 vicryl and then subject to manual traction. (3) Arm three compared drains sutured to the fascia through the tubing versus local tissue incarceration followed by manual traction. (4) Lastly, group four examined drains tethered at two distinct points after which they were subject to manual traction.

Results: Our results showed a 25% drain retention rate when manual traction was applied to 0 vicryl and 2–0 vicryl suture. In contrast, there were no instances of drain retention when suture was closed with 4–0 vicryl. When evaluating for multiple points of fixation, drains tethered in two locations were retained in 87.5% of trials versus drains with a single tether point (25%) representing a statistical significance (P = 0.041). There was no difference in rates of drain retention when pierced through the tubing versus incarcerated in local fascia. Only one of the 16 drains was successfully removed by weighted suspension (8.3%). Attempts at manual traction following weighted suspension resulted in a 50% drain retention rate which was higher than the rates of immediate manual traction (18.8%).

Conclusion: Our results found that manual traction is a reasonable first line approach to address drains tethered by all methods and suture sizes. The use of weighted traction for the management of tethered drains is less effective than manual traction and may result in more retained drain fragments.

Level of Evidence: Level IV.

From Norton Leatherman Spine Center, University of Louisville Medical Center, Louisville, KY (Dr. Laratta, Dr. Shillingford), the Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital at New York–Presbyterian (Dr. Lombardi, Dr. Lenke, Dr. Riew, Dr. Lehman), and Department of Orthopaedic Surgery New York–Presbyterian/Columbia University Medical Center, New York, NY (Dr. Grosso, Dr. Levine).

Correspondence to Dr. Lombardi: jml2285@columbia.edu

Dr. Grosso or an immediate family member has received research or institutional support from Stryker. Dr. Lehman or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of DePuy Synthes, Medtronic, and Stryker; serves as a paid consultant to Medtronic; and serves as a board member, owner, officer, or committee member of AOSpine, the Cervical Spine Research Society, the North American Spine Society, and the Scoliosis Research Society. Dr. Lenke or an immediate family member has received royalties from Medtronic; serves as a paid consultant to DePuy Synthes, K2M, and Medtronic; has received research or institutional support from AOSpine, DePuy Synthes, EOS, the Scoliosis Research Society, and the Setting Scoliosis Straight Foundation; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from the Evans Family Donation and the Fox Family Foundation; and serves as a board member, owner, officer, or committee member of Global Spine Outreach and the Orthopaedic Research and Education Foundation. Dr. Levine or an immediate family member serves as an unpaid consultant to Zimmer Biomet and has received royalties from Zimmer Biomet and Medtronic. Dr. Riew or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Zimmer Biomet, Medtronic, and Zeiss; serves as a paid consultant to Zimmer Biomet and Medtronic; has stock or stock options held in Amedica, Benvenue, Expanding Orthopaedics, PSD, NexGen Spine, Osprey, Paradigm Spine, Spinal Kinetics, Spineology, and Vertiflex; has received research or institutional support from AOSpine; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Advanced Medical, AOSpine, and Zeiss; and serves as a board member, owner, officer, or committee member of AOSpine. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Laratta, Dr. Lombardi, and Dr. Shillingford.

© 2019 by American Academy of Orthopaedic Surgeons
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