J Korean Neurosurg Soc.  2013 Nov;54(5):444-447. 10.3340/jkns.2013.54.5.444.

Usefulness of an Additional Mattress Suture for the Extracranial Drainage Catheter

• Eom DW
• Kim JS
• Jeon KD
• Kim H
• Choi BS

• KMID: 2138366
• DOI: http://doi.org/10.3340/jkns.2013.54.5.444

Abstract

In most intracranial surgery cases, a drain catheter is inserted to prevent the collection of the wound hematoma or seroma. A drain catheter is also inserted to drain the hematoma or the cerebrospinal fluid. The drain catheter itself does not cause complications; but many complications occur during its removal, such as hematoma, seroma, air collection and pseudomeningocele formation. To prevent these complications, neurosurgeons perform a suture on the catheter to remove the site. In this study, an additional horizontal mattress suture and an anchoring suture to the drainage catheter are proposed. This method maintains negative pressure in the catheter insertion site during the catheter removal, compresses the catheter tunnel site and attaches the external wounds strongly. The technique is easy and safe to perform, and does not require an additional suture to remove the catheter.

Keyword

Mattress suture; Intracranial surgery; Catheters

MeSH Terms

Catheters*
Cerebrospinal Fluid
Drainage*
Hematoma
Seroma
Sutures*
Wounds and Injuries

Figure

• 

  Fig. 1 First suture for the anchoring suture. A : The distal end of the catheter exited the skin at least 2 cm from the original incision. B and C : The exiting distal catheter is anchored to the skin at its point of exit on the skin with a 2-0 Mer-silk suture.

• 

  Fig. 2 Additional mattress suture using a 30 cm-long or longer 2-0 Mer-silk. A : The second stitch is sutured along the catheter, approximately 0.5 cm away from the proximal side to the distal side, perpendicular to the first suture and horizontal to the drainage catheter. B : The stitch is again sutured 0.5 cm away from the other side, but now from the distal side to the proximal side. C : The second suture is completed with two sutures that were vertical to the drainage catheter and horizontal to the first suture. D : The remaining silk is wrapped around the drainage catheter outside the skin and fixed using mosquito forceps.

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  Fig. 3 Tie for the removal of the drainage catheter. A and B : The second stitch, which is wrapped around the drainage catheter, was untied, and the first anchoring suture on the skin was cut. C and D : Then the assistant drew the drainage catheter that is connected to the first stitch, at the same time, the operator tied the second suture.

Reference

1. Cabantog AM, Bernstein M. Complications of first craniotomy for intra-axial brain tumour. Can J Neurol Sci. 1994; 21:213–218. PMID: 8000976.

2. Fukamachi A, Koizumi H, Nagaseki Y, Nukui H. Postoperative extradural hematomas : computed tomographic survey of 1105 intracranial operations. Neurosurgery. 1986; 19:589–593. PMID: 3785596.

3. Kadowaki C, Hara M, Numoto M, Takeuchi K, Saito I. CSF shunt physics : factors influencing inshunt CSF flow. Childs Nerv Syst. 1995; 11:203–206. PMID: 7621480.

4. Lavano A, Benvenuti D, Volpentesta G, Donato G, Marotta R, Zappia M, et al. Symptomatic tension pneumocephalus after evacuation of chronic subdural haematoma : report of seven cases. Clin Neurol Neurosurg. 1990; 92:35–41. PMID: 2154353.

5. Liu L, Shen H, Zhang F, Wang JH, Sun T, Lin ZG. Stereotactic aspiration and thrombolysis of spontaneous intracerebellar hemorrhage. Chin Med J (Engl). 2011; 124:1610–1615. PMID: 21740764.

6. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr. Ventriculostomy-related infections : a critical review of the literature. Neurosurgery. 2002; 51:170–181. discussion 181-182. PMID: 12182415.

7. 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; 47:314–316. PMID: 17652918.

8. Park YG, Woo HJ, Kim E, Park J. Accuracy and safety of bedside external ventricular drain placement at two different cranial sites : Kocher's Point versus Forehead. J Korean Neurosurg Soc. 2011; 50:317–321. PMID: 22200013.

9. Winston KR. Dural tenting sutures in pediatric neurosurgery. Pediatr Neurosurg. 1998; 28:230–235. PMID: 9732254.

10. Winston KR. Efficacy of dural tenting sutures. J Neurosurg. 1999; 91:180–184. PMID: 10433304.

11. Yu GJ, Han CZ, Zhang M, Zhuang HT, Jiang YG. Prolonged drainage reduces the recurrence of chronic subdural hematoma. Br J Neurosurg. 2009; 23:606–611. PMID: 19922274.