As Shakespeare once posited: “To drain or not to drain. That is this the question.”
Perhaps it wasn’t him.
Surgeon preference typically dictates whether a drain makes sense. Keeping a hematoma from forming means avoiding one additional nidus of infection. But, a drain (even a closed drain), can also serve as a nidus of infection. I know the pros and cons do not end there. But, I want to change direction.
I received a call from a plastic surgeon in the Northeast. He placed implants in a patient. He also placed a Jackson Pratt drain. He left town for a long weekend. His nurse, who had removed many Jackson Pratt drains, tried to remove this drain. Seemed a little stuck, but, with a little added pressure, only some of the drain came out. The rest never slid out. It was left embedded in the wound, adjacent to the implant. It’s unclear whether a stray suture caught the drain. Or whether the drain was kinked and fractured at a weak point. Or some other hypothesis. But what was clear was that a piece of silastic remained in the patient.
Many surgeons will say that the rest of the drain needs to come out.
But, going back in means opening the wound, and exposing the implant to potential infection.
There’s risk of infection with going back in. There’s risk of infection with leaving the wound alone.
Part of the calculus becomes a matter of optics. Patients expect that we will not leave needles, drains, or surgical tools inside of them. But, we don’t chase all bullets in trauma patients just to get a clean X-ray.
A real risk-benefit analysis must look at the added risk of fishing out the fragment.
No doctor wants to be that defendant explaining why a drain fragment was left in. But, if a patient experiences an added complication just because of the optics, have their interests been served.
There’s no perfect answer to this dilemma.
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