новая папка / 450-550 operativ

Drains may be closed or open system. Drains may be allowed to function naturally by gravity or by capillary action (corrugated drain) or by suction device. It may be connected to wall suction to have continuous or intermittent vacuum suction in wounds.

Drain should be observed daily for its nature and volume of content accurately. Depending on the quantity of the drain, duration of keeping the drain in situ is decided. Open drains like Penrose and corrugatedshould have protective dressings over it. Amountof soiling should be assessed for possible quantity of drainage and type – bile/ faecal/serous/serosanguineous/purulent/gastric.

Passive Drains

Passive drains even though used by many surgeons, are not very suitable as their e cacy is inadequate and complications are more. Penrose drain and corrugated rubber drains are commonly used. Tube drains like Malecot’s/Foley’s catheters/nasogastric tubes are also often used for this purpose. Flat drains outside are covered by dressing pads. Tube drains are connected to sterile container (urosac bag) or sterile glove outside. Tube drains are better than at drains

(Figs 18-48 to 18-50).

Penrose Drain

A Penrose drain is a named for the American gynecologist Charles Bingham Penrose (1862–1925), placed in a wound to drain uid. It consists of a soft rubber tube placed in a wound area, to prevent the buildup of uid. It is a passive open drainage system. A Penrose drain removes uid from a wound area. It is used after a surgical procedure iscompletetopreventthe areafromaccumulating uid,such as blood, which could serve as a medium for bacterial infection. In podiatry

(diseases and management of foot diseases), a Penrose drain is often usedasatourniquetduring a nail excisionoringrowntoenailexcision. It can also be used to drain CSF in a hydrocephalus patient. It is a quadrangular at tube made up of radiopaque thin rubber sheet. It is available as prepacked sterile drain with a safety pin. Safety pin prevents drain getting retracted into the wound while in use. Head of the safety pin should be crimped and closed to prevent injuring the patient’s skin. Di erent sized Penrose drains are available. Multiple Penrose tubes can be placed. It is inexpensive and creates brosis to form atract in 10days.It drainspassivelyby meregravity andover ow. In oozing area blood may clot and block the drain. Infection into the area from outside is a possible drawback (Fig. 18-51).

Active (Negative Pressure) Drains

Negative pressure causes – continuous wound cleaning thereby decrease the bacterial burden in the wound, remove substances that inhibit wound healing; promotes continuous removal of uid like exudates so that prevents the mechanical compression by accumulated exudates into the capillaries at the site which restricts the flow of blood into wound site; causes wound retraction and approximation ofwoundedges; createsexternally appliedmechanical stress in the tissues stimulating matrix synthesis and cell proliferation; promotes healthy granulation tissue formation; decreases interstitial oedema which improves the blood ow.

Negative Pressure Wound Therapy

It is used in infected wounds often in abdominal wall. It creates continuous or intermittent suction of the wound content to keep the woundsurfacedrainwhich promotesformationofhealthygranulation tissue and so wound healing.