Wound drains are mostly used in postoperative wound care. They are also helpful as an additional aid in the care of chronic wounds. A wound drain allows blood and wound secretions to drain away and pulls the wound edges together. This can significantly support the healing process.
What is wound drainage?
Wound drainage allows blood and wound secretions to drain and pulls the wound edges together. In this way, the healing process can be significantly supported. The term drainage comes from the English to drain, which directly translated means “to drain” and can be indirectly paraphrased as “to drain”. In wound care and in the wound healing process, the mode of action of this type of treatment is thus almost self-explanatory. Per se this means: What is harmful to the organism is drained away so that what is beneficial to the healing process can take effect. Infections and hematoma formation are avoided, wound healing can be monitored and complications ruled out.
Function, effect, and goals
There are several types of wound drains; they differ mainly in whether they are active or passive drains. Their use depends on the type of wound and the goal of the actual wound management. Especially for postoperative wound management or organ drainages such as thoracic drainage, a tube system is usually used; these are made of hygienic plastic. In postoperative care, the drain remains in the wound only for a short time and is removed again promptly. If a chronic wound is to be treated, adhesive drains are often used. One example of this is pressure ulcers (decubitus), a problem particularly in geriatric care or with bedridden patients. The declared aim here is to give the healing process sufficient time to close from the center of the wound to the outside. This is only possible if secretion formation and thus germ foci are avoided. This type of drainage must be changed regularly, observing absolute hygienic standards, and usually requires a longer period of use. If a drainage tube is used, one end of a so-called drain (hose, tube) is inserted directly into the wound to ensure constant contact with the secretion. The other end is drained out of the wound suture a few centimeters away from the wound, which is done simultaneously while the suture is being placed. This type of wound care is associated with a bag fixed to the body or a solid container removed from the body. Another option is the application of a tissue, such as a tamponage made of gauze. However, this method follows a different principle. The declared aim of all types of wound drainage is to drain the wound secretion or blood efficiently from the wound. This is the only way to avoid contamination with germs and subsequently dangerous wound infections. Different methods of wound drainage are therefore used in wound management. They are each based on different physical modes of action. For example, gravity can be used to direct the wound secretion, which collects at the deepest point of the wound, into a correspondingly deeper container. This type is usually used for large wounds with a correspondingly large suture. Another possibility of drainage is found in the force of adhesion (attraction); here the body fluid is attracted and absorbed by gauze or other materials and can then be removed with the drainage. Meanwhile, appropriately designed foams are used in this type of drainage. They are usually made of polyurethane. This fabric is much more in line with today’s hygiene standards, as there is less of a breeding ground for harmful germs. Another physical force is used in suction drainage. This is a closed drainage system. Here, the drainage hose is connected to a bag or collection vessel, which is under negative pressure. A constant suction is generated; this allows blood and wound secretions to be suctioned out. A continuous externally generated negative pressure is usually preferred here to so-called vacuum bottles; because depending on the degree of filling of the containers, the suction can lose intensity here. If, on the other hand, it is generated by manually or electrically operated pumps, for example by a bellows, constant suction is guaranteed. A distinction is made between controlled and uncontrolled suction.For some wounds, especially those already affected by infection, an extended tube system is used. In this case, an irrigation fluid is introduced into the wound through the first drain and slides out again through the other tube. There are perforations on the tubes, and the irrigation fluid is usually so-called Ringer’s solution.
Risks, side effects, and hazards
However, wound drains and their use can also carry risks. Opinions now differ on the pros and cons of their use. Whereas the placement of a drain was once advocated for almost every operation, the risks are now being debated over the benefits. Some studies are now said to show that it cannot be directly proven that it promotes wound healing. Drains may also be responsible for causing undesirable complications. While wound drains are gateways to drain pathological body fluids, they can promote access of infectious germs to the wound in the same way. This, in turn, can lead to dangerous wound infections in the worst case scenario. The body can also react to the drainage system with defense, since it is recognized as a foreign body. If drains remain in the body for a long period of time, adhesions can also form. Bleeding can occur, pressure problems due to the position of the tube or complications due to kinking by the patient himself also cannot be ruled out.
