Columbus, Ohio; and Blacksburg, Va.
From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center; and the Department of Business Information Technology, Pamplin College of Business, Virginia Tech.
Plast Reconstr Surg. 2018 Jun;141(6):1542-1549. doi: 10.1097/PRS.0000000000004413.
Closed-suction drains are widely used to reduce the incidence of seroma whenever potential spaces are surgically created. However, few studies have examined the parameters that affect drain efficacy.
An in vitro model was created to assess the effects of tubing length, tubing size, tubing type, fluid viscosity, fluid clotting, evacuator type, evacuator squeeze method, evacuator fill, and evacuator pressure on the performance of closed-suction drains.
Fluid flow rate through the drain increases with increasing intracavitary tubing length, decreasing extracavitary tubing length, increasing tubing diameter, increasing negative pressure, decreasing fluid viscosity, and the use of perforated rather than fluted drains. Bulbs generate more effective suction when squeezed "side-to-side" than when squeezed "bottom-up," and evacuators were only able to generate half the maximal negative pressure when 25 percent full or greater. Stripping the drain tubing helped relieve obstruction caused by clotting.
The authors' findings have practical clinical implications for surgeons hoping to maximize the efficacy of closed-suction drains. Through this comprehensive review of the literature and in vitro analysis of relevant variables that affect drain function, the performance of closed-suction drains can be optimized by increasing intracavitary tubing length, decreasing extracavitary tubing length, increasing tubing diameter, increasing the pressure differential, using perforated drains, squeezing bulbs side-to-side, stripping drain tubing frequently, and evacuating containers whenever they are 25 percent full.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
只要在手术时形成了潜在空间，就广泛使用密闭式吸引引流来降低血清肿的发生率。然而，很少有研究检查过影响引流效果的参数。
建立了一种体外模型，以评估管腔长度、管腔大小、管腔类型、流体粘度、流体凝结、吸引器类型、吸引器挤压方式、吸引器填充量和吸引器压力对密闭式吸引引流效果的影响。
通过引流管的流体流速随着管腔内置管长度的增加、管腔外置管长度的缩短、管腔直径的增加、负压的增加、流体粘度的降低以及使用多孔而非槽式引流管而增加。当挤压吸引器“侧-侧”时，比挤压“底-顶”时产生更大的吸力，并且当吸引器填充量达到或超过 25%时，只能产生最大负压的一半。冲洗引流管有助于缓解因凝结而导致的阻塞。
作者的研究结果对希望最大限度提高密闭式吸引引流效果的外科医生具有实际的临床意义。通过对影响引流功能的相关变量的文献综述和体外分析，通过增加管腔内置管长度、缩短管腔外置管长度、增加管腔直径、增加压力差、使用多孔引流管、侧-侧挤压吸引器、频繁冲洗引流管以及在容器填充量达到 25%时立即排空等方法，可以优化密闭式吸引引流的性能。
临床问题/证据水平：治疗，V 级。
