Drainage may justly be regarded as a matter of antisepsis. It prevents sepsis by creating a current which moves away from the wound, and by depriving bacteria of their chief pabulum—the wound exudates. Drainage facilitates repair by relieving tension. But when these points are made, it is important to note that drainage is not an unmixed good; it is a necessary evil due to its nature as a foreign body, necessitating frequent dressing changes and potentially injuring granulations. It keeps the wound open and delays healing, sometimes predisposing to complications like fistula, hernia, or intestinal obstruction in abdominal cavities.
The emergency surgeon will more often drain than the hospital surgeon in formal operations. Aseptic wounds do not require drainage unless there is much post-operative oozing, such as large amputations. Suspected wounds are not drained after the third day if infection has not appeared or seems unlikely to develop. Infections should be drained until all discharges cease.
The means of drainage include tubes, gauze, and open wounds; or combinations thereof. Rubber tubes are best for draining large cavities and abscesses, while plain sterile gauze is efficient for removing exudates but may cause adhesions and pain upon removal. Wick drains and cigarette drains combine tubal and capillary drainage methods.
Abscesses and acute spreading infections should be drained with tubes. Accidental incised wounds are often not completely sutured to allow natural drainage. Operative wounds of the soft parts in emergency practice may be best drained superficially, all layers closed except skin. Compound fractures and dislocations require only skin wound drainage unless infection develops.
<Callout type="important" title="Critical Rule">Always ensure proper drainage for infected wounds to prevent sepsis.</Callout>
Further details on specific operations requiring drainage will be provided in subsequent chapters.
Key Takeaways
- Drainage is crucial for preventing sepsis and promoting healing by removing wound exudates.
- Different drainage methods are suitable for different types of wounds based on their nature and location.
- Proper drainage must be maintained until all discharges cease to prevent complications.
Practical Tips
- Use rubber tubes for large cavities or abscesses, ensuring they are fenestrated and anchored properly.
- Combine gauze with wick drains or cigarette drains for efficient removal of exudates without causing adhesions.
Warnings & Risks
- Frequent dressing changes may be necessary when using drainage tubes to prevent infection.
- Improper use of drainage methods can lead to complications such as fistula, hernia, or delayed healing.
Modern Application
While the principles of wound drainage remain relevant today, modern sterile techniques and materials have significantly improved outcomes. Understanding historical methods provides a foundation for effective emergency care when advanced medical resources are unavailable.
Frequently Asked Questions
Q: What types of wounds typically require drainage?
Infected wounds or those suspected to be infected should always be drained, whereas aseptic wounds generally do not unless there is significant post-operative oozing.
Q: How long should infections be drained?
Infections should continue to be drained until all discharges cease. If infection develops later, drainage must be resumed.
Q: What are the advantages of combining gauze with wick drains or cigarette drains?
Combining these methods allows for efficient removal of exudates without causing adhesions and can provide hemostasis when necessary.