Drain Anchoring and Removal Technique Without Change of Dressing in Transtibial Amputation.

Introduction

Routine or selective insertion of drains following below knee or transtibial (TA) amputations is not uncommon in vascular patients who are often on antiplatelet agents or anticoagulants prior to their operation. There is no robust evidence regarding dressings and drains used in the management of TA stump. Routine use of drains may help to obliterate dead space, and reduce haematoma formation and ultimately wound infection. The drain, when inserted, is customarily removed within 48 hours to eliminate any risk of increased infection risk that may be associated with use of drains. It is preferable not to suture the drain to the skin so that removal does not disturb the dressings and bandages prematurely. On the other hand, the drain should remain in place for the intended duration.

This study describes a technique that fixes the drain securely to allow its removal without the need to change the dressing. This technique applies only when soft dressings like orthopaedic wool and crepe bandage have been employed – a common practice in the UK.

Surgical Technique

The TA stump is fashioned either as a long posterior flap or skew flaps. A size 10 French silicon tube redivac suction drain is placed deep in the muscle and positioned lateral to the stump through a separate skin stab incision. Once the wound has been closed and covered with wool, a crepe bandage is wrapped around the stump with excess kept rolled. A series of interrupted 2/0 silk sutures are placed through the roll and into the underlying dressing layers. This creates a firm tubular part of dressing to which the most cranial suture also incorporates the free end of the drain (Fig. 1). This suture is labelled “drain” and kept long; the drain may easily be removed without disrupting the dressings by cutting the stitch marked “drain” and pulling out the drain.

Figure 1

Drain anchored to rolled crepe bandage with most cranial suture marked as drain.

Discussion

In a scenario where it is important to remove the drain much earlier than the dressing; the technique described allows for the safe removal of the drain while the dressings are left intact for the desired duration. There is a need for more randomised control trials for dressings and drains used in managing TA stumps.

Conflict of Interest

None.

Funding

None.