Intervention Review

Closed suction surgical wound drainage after orthopaedic surgery

  1. Martyn J Parker1,*,
  2. Vicki Livingstone2,
  3. Rupert Clifton3,
  4. Andrew McKee4

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 20 MAR 2006

DOI: 10.1002/14651858.CD001825.pub2


How to Cite

Parker MJ, Livingstone V, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD001825. DOI: 10.1002/14651858.CD001825.pub2.

Author Information

  1. 1

    Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough, Cambridgeshire, UK

  2. 2

    University of Otago, Preventive & Social Medicine, Dunedin, New Zealand

  3. 3

    Peterborough NHS Trust, Department of Trauma and Orthopaedic Surgery, Peterborough, UK

  4. 4

    Peterborough Hospital, Department of Orthopaedic Surgery, Peterborough, UK

*Martyn J Parker, Orthopaedic Department, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, PE3 6DA, UK. martyn.parker@pbh-tr.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Closed suction drainage systems are frequently used to drain fluids, particularly blood, from surgical wounds. The aim of these systems is to reduce the occurrence of wound haematomas and infection.

Objectives

To evaluate the effectiveness of closed suction drainage systems for orthopaedic surgery.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2006), and contacted the Cochrane Wounds Group. We also searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1), and MEDLINE (1966 to March 2006). Articles of all languages were considered.

Selection criteria

All randomised or quasi-randomised trials comparing the use of closed suction drainage systems with no drainage systems for all types of elective and emergency orthopaedic surgery.

Data collection and analysis

Two authors independently assessed trial quality, using a nine item scale, and extracted data. Where appropriate, results of comparable studies were pooled.

Main results

Thirty-six studies involving 5464 participants with 5697 surgical wounds were identified. The types of surgery involved were hip and knee replacement, shoulder surgery, hip fracture surgery, spinal surgery, cruciate ligament reconstruction, open meniscectomy and fracture fixation surgery.

Pooling of results indicated no statistically significant difference in the incidence of wound infection, haematoma, dehiscence or re-operations between those allocated to drains and the un-drained wounds. Blood transfusion was required more frequently in those who received drains. The need for reinforcement of wound dressings and the occurrence of bruising were more common in the group without drains.

Authors' conclusions

There is insufficient evidence from randomised trials to support the routine use of closed suction drainage in orthopaedic surgery. Further randomised trials with larger patient numbers are required for different operations before definite conclusions can be made for all types of orthopaedic operations.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Wound drains in orthopaedic surgery (surgery on the joints or limbs)

Drainage systems may be used to drain fluid, mostly blood, from surgical wounds after an operation. The drains can either be open or closed. Closed drains use vacuum bottles and plastic conduits to draw fluid away from the wound by producing a negative pressure. They have been evaluated within trials for a number of elective and emergency orthopaedic operations. Closed surgical drainage systems reduce the need for reinforcement of the dressing and bruising around the wound, but increase the need for blood transfusion. Wound drains do not appear to have any effect on the occurrence of wound infections, large blood collections within the wound (haematomas), or the need for additional surgery to correct wound healing complications.

Closed suction wound drains in orthopaedic surgery are of doubtful benefit.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

骨科手術術後傷口密閉式抽吸引流

傷口密閉式抽吸引流時常在外科傷口上被用來引流液體,特別是血液。這一些系統被設計的目的是用來降低傷口發生血腫以及感染的機率。

目標

用來評估密閉式抽吸系統在骨科手術術後的效果。

搜尋策略

我們搜索了考科藍骨骼、關節和肌肉創傷專業註冊組織(2006 三月),也諮詢考科藍傷口團體,並搜尋了考科藍臨床試驗中央資料庫(考科藍圖書館 2006, Issue 1),以及MEDLINE 的資料 (1996 至2006 三月)。所有語言的論文都是參考的對象。

選擇標準

所有隨機或是類似隨機的試驗,在急診或已安排的各種骨科手術中,比較密閉式引流系統以及沒有引流系統的差別。

資料收集與分析

兩位作者各自獨立的評估各個試驗的品質, 其中包括使用「九項評估指標」以及粹選的資料。其中可以比較的研究就被收集起來。

主要結論

結果包含了36個研究,包含5464位試驗者以及5697個傷口。這些手術包含了髖關節和膝關節置換手術、肩膀手術、髖關節骨折手術、脊椎手術、十字韌帶重建手術、開放性半月軟骨切除手術以及骨折固定手術。這些資料顯示出這些分成引流以及未引流的兩種傷口中,在傷口感染、血腫、傷口裂開或是再開刀的比例並沒有顯著的差異。輸血在有引流的傷口族群中比例較高,傷口需要再次換藥以及發生瘀青的比例則在沒有引流傷口的族群較高。

作者結論

從隨機試驗中沒有足夠的證據來支持骨科手術後常規使用密閉式抽吸引流。未來可能需要更大量數目不同骨科手術病人的隨機臨床試驗來對不同手術部位是否建議使用密閉式抽吸引流作較客觀的結論。

翻譯人

本摘要由臺北榮民總醫院余紹華翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

傷口引流在骨科手術(關節或四肢的手術)的應用。引流系統用來手術術後傷口引流液體,大部分是血液。引流可以分為開放式或是密閉式。密閉式引流是利用真空瓶以及塑膠管路產生的負壓來抽吸液體。數個試驗針對計劃性及急診的骨科手術已評估過密閉式引流的效果。密閉式引流系統可以降低傷口再次換藥的需要以及傷口的瘀青,但是會增加輸血的需要性。傷口引流似乎對於傷口感染、大量血液累積在傷口(血腫)的發生率,或是改善傷口併發症而須再次手術的機率並沒有影響,密閉式傷口引流應用在骨科手術是否有益處目前仍是存疑的。