The value of suction wound drain after carotid and femoral artery surgery: a randomised trial using duplex assessment of the volume of post-operative haematoma.
BACKGROUND
The use of vacuum suction drains after carotid endarterectomy (CEA) and groin dissection for arterial reconstruction surgery remains controversial. A large multicentre prospective randomised trial would be needed to show any difference if clinical end points (infection and haematoma) are used. Therefore, we conducted a study to evaluate the value of wound drainage using accurate duplex measurement of haematoma expecting a 25% difference in volume between drained and non-drained wounds.


METHODS
Seventy consecutive patients undergoing CEA and 73 patients who underwent 106 groins dissection were separately and blindly randomised into two groups: group (a) with wound drain and group (b) without wound drain. A duplex scan was carried out post-operatively to document the presence and volume of any wound haematoma.


RESULTS
The majority of wounds did not show any evidence of collections. 1. In the CEA patients duplex scan revealed wound haematoma in 8 patients with a median volume of 25 ml (5-65) in group (a) in comparison to 7 wound haematomas 31 ml (3-72) in group (b). Median suction drain drainage was 42 ml (10-120) when used. There was no significant difference between the two groups. Three patients 4.3% (two from the drain group) underwent evacuation of haematoma post-operatively.2. In the groin dissection patients most of the documented collections were trivial. Ultrasound scans showed 21 collections (20%), of these 7 (34%) were in group (a) and 14 (66%) were in group (b). There was no significant difference in wound collections between the two groups (p = 0.28). Only 5 collections (75%) exceeded 10 ml, three of them were in the drain group. One patient (1%), who did not have a drain, developed a wound collection, which needed re-exploration. When a drain was used the median drainage was 64.5 ml (range 10-220).


CONCLUSIONS
These results based on accurate measurement of wound collection suggest that there is no benefit in terms of reduction of the volume of haematoma on wound drainage after CEA or arterial reconstruction surgery involving the groin. A selective policy of use of drainage is therefore recommended.
Youssef
F
F
University Department of Surgery, Royal Free Hospital NHS Trust and Royal Free and University College Medical School, University College London, London, UK. youssef@rfc.ucl.ac.uk
Jenkins
M P
MP
Dawson
K J
KJ
Berger
L
L
Myint
F
F
Hamilton
G
G
D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D002339:Carotid Arteries / Q000503:physiopathology / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery; D006119:Groin / Q000601:surgery; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013396:Suction / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex; D014618:Vacuum