J Cerebrovasc Endovasc Neurosurg.  2015 Sep;17(3):194-202. 10.7461/jcen.2015.17.3.194.

Necessity of Surgical Site Closed Suction Drain for Pterional Craniotomy

Affiliations
  • 1Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea. cwpark@gilhospital.com

Abstract


OBJECTIVE
The aim of this study was to assess the benefit of using a prophylactic surgical site closed suction drain in pterional craniotomy.
MATERIALS AND METHODS
A retrospective review was conducted on 607 consecutive patients who underwent a pterional craniotomy for treatment of intracranial anterior circulation aneurysms over a 5-year period. Between January 2000 and December 2004, 607 patients were divided into two groups, those who had a prophylactic suction drain during closure of the surgical site (drain group, DG) and those who did not (non-drain group, NDG). Head computed tomography (CT) was taken routinely on postoperative day (POD) 1, 7, and 14. Patients' demographics, incidence of surgical site complications, and courses of surgical site healing which were evaluated radiologically by the thickness of the surgical site myocutaneous layer, were analyzed between DG and NDG.
RESULTS
Patients' demographics and characteristics did not differ significantly between the two groups. The head CT showed that the degree of changes in the postoperative surgical site thickness was 148% at POD 1, 209% at POD 7, and 198% at POD 14 in DG, and 118% at POD 1, 152% at POD 7, and 158% at POD 14 in NDG compared to the preoperative value. Postoperative surgical site hematoma was 7.9% (22/274) in DG and 2.4% (8/333) in NDG.
CONCLUSION
Prophylactic use of an epidural and/or subgaleal closed suction drain does not appear to be necessary for prevention of postoperative surgical site hematoma as well as for promotion of surgical site healing in pterional craniotomy.

Keyword

Craniotomy; Drainage; Surgical wound infection

MeSH Terms

Aneurysm
Craniotomy*
Demography
Drainage
Head
Hematoma
Humans
Incidence
Retrospective Studies
Suction*
Surgical Wound Infection

Figure

  • Fig. 1 Thickness of myocutaneous layer (in mm) from the surface of the skull to that of the scalp on the pterional craniotomy site at or just above the level of zygomatic arch on the head CT slice. A: Preoperative thickness of myocutaneous layer (a). B: Postoperative 7 day's thickness of myocutaneous layer (b). Postoperative thickness of myocutaneous layer value ; (b/a) × 100 (%).


Reference

1. Alexander JW, Korelitz J, Alexander NS. Prevention of wound infections. A case for closed suction drainage to remove wound fluids deficient in opsonic proteins. Am J Surg. 1976; 7. 132(1):59–63. PMID: 782267.
2. Beer KJ, Lombardi AV Jr, Mallory TH, Vaughn BK. The efficacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg Am. 1991; 4. 73(4):584–587. PMID: 2013597.
Article
3. Browett JP, Gibbs AN, Copeland SA, Deliss LJ. The use of suction drainage in the operation of meniscectomy. J Bone Joint Surg Br. 1978; 11. 60-B(4):516–519. PMID: 711799.
Article
4. Chan KW, Datta NN. Iatrogenic acute subdural hematoma due to drainage catheter. Surg Neurol. 2000; 12. 54(6):444–446. PMID: 11240173.
Article
5. Cobb JP. Why use drains? J Bone Joint Surg Br. 1990; 11. 72(6):993–995. PMID: 2246304.
Article
6. Cruse PJ, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973; 8. 107(2):206–210. PMID: 4719566.
Article
7. Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004; 1. 9:283–289. PMID: 14766366.
Article
8. Drinkwater CJ, Neil MJ. Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty. 1995; 4. 10(2):185–189. PMID: 7798099.
Article
9. Dunlop MG, Fox JN, Stonebridge PA, Clason AE, Ruckley CV. Vacuum drainage of groin wounds after vascular surgery: a controlled trial. Br J Surg. 1990; 5. 77(5):562–563. PMID: 2191752.
Article
10. Esler CN, Blakeway C, Fiddian NJ. The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br. 2003; 3. 85(2):215–217. PMID: 12678355.
11. Guangming Z, Huancong Z, Wenjing Z, Guoqiang C, Xiaosong W. Should epidural drain be recommended after supratentorial craniotomy for epileptic patients? Surg Neurol. 2009; 8. 72(2):138–141. discussion 141PMID: 19608006.
Article
12. Healy DA, Keyser J 3rd, Holcomb GW 3rd, Dean RH, Smith BM. Prophylactic closed suction drainage of femoral wounds in patients undergoing vascular reconstruction. J Vasc Surg. 1989; 8. 10(2):166–168. PMID: 2527316.
Article
13. Higazi I. Epidural hematoma as complication of ventricular drainage. Report of a case and review of literature. J Neurosurg. 1963; 6. 20:527–528. PMID: 14186075.
14. Jepsen OB, Larsen SO, Thomsen VF. Post-operative wound sepsis in general surgery. II. An assessment of factors influencing the frequency of wound sepsis. Acta Chir Scand Suppl. 1969; 396:80–90. PMID: 5257687.
15. Kim YH, Cho SH, Kim RS. Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties. J Arthroplasty. 1998; 2. 13(2):156–161. PMID: 9526208.
Article
16. Lewis RT, Goodall RG, Marien B, Park M, Lloyd-Smith W, Wiegand FM. Simple elective cholecystectomy: to drain or not. Am J Surg. 1990; 2. 159(2):241–245. PMID: 2405730.
Article
17. Magee C, Rodeheaver GT, Golden GT, Fox J, Edgerton MT, Edlich RF. Potentiation of wound infection by surgical drains. Am J Surg. 1976; 5. 131(5):547–549. PMID: 1275140.
Article
18. Meguro T, Terada K, Hirotsune N, Nishino S, Asano T. Postoperative extradural hematoma after removal of a subgaleal drainage catheter--case report. Neurol Med Chir (Tokyo). 2007; 7. 47(7):314–316. PMID: 17652918.
19. Overgaard S, Thomsen NO, Kulinski B, Mossing NB. Closed suction drainage after hip arthroplasty. Prospective study of bacterial contamination in 81 cases. Acta Orthop Scand. 1993; 8. 64(4):417–420. PMID: 8213118.
Article
20. Redon H, Jost , Troques . Closure under reduced atmospheric pressure of extensive wounds. Mem Acad Chir (Paris). 1954; Mar-Apr. 80(12-14):394–396. PMID: 13176072.
21. Reilly TJ, Gradisar IA Jr, Pakan W, Reilly M. The use of postoperative suction drainage in total knee arthroplasty. Clin Orthop Relat Res. 1986; 7. (208):238–242. PMID: 3720129.
Article
22. Stevens DB. Postoperative orthopaedic infections. A study of etiological mechanisms. J Bone Joint Surg Am. 1964; 1. 46:96–102. PMID: 14106556.
23. Toshniwal GR, Bhagat H, Rath GP. Bradycardia following negative pressure suction of subgaleal drain during craniotomy closure. Acta Neurochir (Wien). 2007; 10. 149(10):1077–1079. discussion 1079PMID: 17616841.
Article
24. Van Roost D, Thees C, Brenke C, Oppel F, Winkler PA, Schramm J. Pseudohypoxic brain swelling: a newly defined complication after uneventful brain surgery, probably related to suction drainage. Neurosurgery. 2003; 12. 53(6):1315–1326. discussion 1326-7PMID: 14633298.
Article
25. Walid MS, Abbara M, Tolaymat A, Davis JR, Waits KD, Robinson JS 3rd, et al. The role of drains in lumbar spine fusion. World Neurosurg. 2012; Mar-Apr. 77(3-4):564–568. PMID: 22120372.
Article
26. Waugh TR, Stinchfield FE. Suction drainage of orthopaedic wounds. J Bone Joint Surg Am. 1961; 10. 43-A:939–946. PMID: 14040185.
Article
27. Willemen D, Paul J, White SH, Crook DW. Closed suction drainage following knee arthroplasty. Effectiveness and risks. Clin Orthop Relat Res. 1991; 3. (264):232–234. PMID: 1997239.
28. Yasargil MG, Reichman MV, Kubik S. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical article. J Neurosurg. 1987; 9. 67(3):463–466. PMID: 3612281.
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