The use of drains is a routinue part of many procedures in plastic surgery. From procedures such as facelifts, breast reductions and tummy tucks, drains play an important role in the prevention of postoperative complications. While patients have to tolerate a tube(s) sticking out of their body and go through the process of emptying and recording its output, they happily await the day when it can finally be removed. The removal of a surgical drain often signals the end of the first phase of recovery.
The importance of a surgical drain is just as important after it has been removed than when it was in. This is particularly true in most body contouring operations, particularly tummy tucks, abdominal panniculectomies and circumferential body lifts. But most patients understandably don’t appreciate the biology of their use and this often leads to the one complication that are used to prevent…seroma or fluid accumulation.
When large open cavities are left behind and underneath a closed incision, this unhealed space will fill with fluid. This fluid is largely a lymphatic leak with some intial blood that is leaking from the raw surfaces of the cut tissues. The larger the unhealed space (such as a tummy tuck), the greater in amount and longer in time this fluid will leak into this space. This collection of fluid prevents the raw surfaces of the cavity tissues from healing together and also serves as a perfect culture medium for bacterial growth.
Drains pull off this fluid, accomplishing a reduction in the fluid interface between the raw surfaces. Like the edges of a surgical incision, keeping the raw surfaces of the cavity close together helps them heal to each other. Once this happens the cavity is obliterated and no more fluid will accumulate since the space is gone The time it takes for wound edges to heal often coincides with the slowing down of the fluid leak from the tissues as the cut ends of the lymphatic vessels seal themselves off.
While ideally a surgical drain should stay in as long as the lymphatic leak is occurring, it is impossible to know precisely when the fluid leak is over. The longer drains stay in the better but there does come a point of patient tolerance and often drains become loose. Sometimes they fall or get pulled out and often become sore and painful where they exit through the skin. In tummy tucks, for example, this point is often reached around 10 days or so.
When drains come out, however, the fluid leak may still not be over. While the body can absorb a certain amount of fluid in a cavity, too much fluid leak will create a collection known as a seroma. Once the drains are out, the patient can do two things that can help prevent this problem. The wearing of a circumferential compression binder helps push the sides of the cavity together to help encourage sticking and healing together. Keeping one’s activities limited (no exercise or extensive walking) also decreases fluid leak. More activity acts as a pressure pump, releasing more fluid into the surgical area. Just because a surgical drain is out is not a license to become more active. One should limit their activity for at least two weeks after a drain is out to prevent the likelihood of a seroma build-up.
While seromas can be treated by tapping (needle aspiration in the office), prevention is always better. In my Indianapolis plastic surgery experience, about 30% of tummy tucks for example will develop a seroma that needs to be treated. Limiting one’s activity after drain removal and wearing a binder can help keep one in the more favorable majority.
Dr. Barry Eppley
Indianapolis, Indiana