Practical draining technique using Foley catheter for maxillofacial spatial infections.

Sir,

Surgical exploration of involved spaces and maximum pressure reduction of pus-filled spaces are main steps of abscess treatment.[1] Accurate placement of drains in the involved compartments provides effective drainage and fast resolution of the spatial infections. The general purpose of the Foley catheter is to drain urine but it may serve as a very effective abscess drain.

It could be used both as a passive or active drain. The rigidity and diameter of a Foley catheter poses advantages over Penrose drains, which allows placement and directing the drain into desired facial planes without any collapse and folding of its tip.[2] The Foley catheter allows monitoring of the draining process with computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography [Figure 1]. In some catheter models, a thin wire is integrated along the long axis of the catheter for easier radiological identification. This gives the chance to visualize the exact position of the catheter in situ.

Figure 1

CT showing the localization of Foley catheters in situ

The most common sizes are 10 F (3.3 mm) to 28 F (9.3 mm). We prefer mostly 14 F or 16 F sizes for abscess draining. After aseptic skin cleansing, the skin is incised with no. 11 blade and blunt dissection is performed with a curved clamp until pus-filled space is entered. The Foley catheter is advanced with the clamp through the dissected space and secured to skin with 3/0 silk suture. The space is irrigated with a sterile saline and aspirated back with negative pressure [Figure 2]. Most of irrigating saline drains along the catheter through skin incision.

Figure 2

Irrigation through Foley catheters

The advantage of Foley catheter in abscess drainage is for deep space infections that allow effective irrigation even in spaces difficult to irrigate when Penrose drains are used.[3] With daily irrigation, the bacterial concentration is diluted and resolution of infection is accelerated with this technique.[4]

To our knowledge, Foley catheter as a drain for fascial space infection has not been reported. They are practical and cheap as an abscess drain for fascial space infections.