Post-Operative Drains In Plastic Surgery: Dispelling the Myths

BACKGROUND: While intraoperatively placed closed-suction drains prevent the accumulation of fluid and allow for its egress, many surgeons fear their presence serves as a portal for bacterial entry into deep surgical spaces. As a result, and despite a lack of evidence supporting the practice, postoperative antibiotics are often prolonged while drains are in place. We therefore sought to examine the microbiology of indwelling drains and the relationship between drain colonization and surgical site infections.

METHODS: All patients who underwent intraoperative Jackson-Pratt drain placement by a single surgeon over an 8-month period were eligible. Only patients whose drains were removed by the same surgeon in the office after at least 5 days (under sterile conditions at the clinically indicated time) were included.  The same 1 cm segment of each drain (the 5^th row of holes from the base) was sent to microbiology for culture and sensitivity testing. Patient demographics, procedures, and drain locations/durations were recorded, as well as the selection and duration of perioperative and postoperative antibiotics.

RESULTS: Thirty-nine patients with 69 drains were included in the study (age range 25-95y, mean 58).  The most common surgical procedures included abdominal wall reconstruction and paraspinous muscle flap advancement.  Drains were in place for 5-43d (mean 13.2d). Fifty-nine percent of drains had positive cultures, including coagulase-negative Staphylococcus (26%), Enterococcus faecalis (10%), and methicillin-sensitive Staphylococcus aureus (4%).   All patients received at least 1 dose of perioperative antibiotics. Twenty-seven patients received postoperative antibiotics (range 2-42d, mean 12.2d). There was one case of cellulitis. One patient required breast tissue expander explantation due to infection. Thirty-one drains (45%) were placed in the presence of prosthetic material.

CONCLUSIONS: Over half of all drains are colonized with bacteria, including unusual species such as Corynebacterium jeikeium, Micrococcus luteus, and diptheroids.  Despite this, our wound complication rate was extremely low (5%).  We conclude that drains may be left in place for an extended period of time without increasing the risk of infection, even in the presence of prosthetic material.  Furthermore, these data suggest that use of antibiotics to “cover” drains is unnecessary given the potential for detrimental consequences of superfluous antimicrobial therapy including multi-drug resistant flora and pseudomembranous colitis.