DRAINAGE

1. GENERAL
Drain means dry . So the farmer who has too wet field oumarécageux will he place drains for collecting and removing stagnant water, enutilisant the natural slope of the ground (or slope ) .
Surgery , drainage seeks to temporarily facilitate the evacuation of a versl'extérieur liquid or avoid (reconstruction of an abnormal collection. According celiquide circumstances may be blood , pus, serous fluid , urine , bile or stool or the liquidedigestif .

The drain can be placed in a natural cavity (peritoneal cavity , bladder, pleura, pericardium , articulation, bile ... ) or a newly formed cavity, infectious outraumatique (abscess , hematoma, wound, surgical or traumatic separation ... ) .
Drainage patterns and the type of drain selected depend strongly on the cavity to drain .

2 . METHOD OF DRAINAGE

- Passive drainage simply uses the differences in pressure between the outside and cavitéconcernée . Our farmer who uses the natural slope of the ground makes undrainage liabilities. Similarly the drain placed in the abdominal cavity is subjected intraabdominal àl'hyperpression and liquids will tend to be discharged through the outside where drainvers normal atmospheric pressure prevails .

- In contrast , the active drainage involves an external vacuum system. For lepaysan , it is a vacuum pump with which the water pockets which are evacuated pasd'elles themselves . In medicine , the vacuum provided by a vacuum source ( with a central suction outlet etmobile electric pump system or independent ) is used. For example , a chest drainage ( the pleura ) may be for aspirative
Compensate for the depression of the pleural cavity during inspiration .
When using this type of suction drain , we need to control and modulate ladépression (measured in inches of water ) not to create tissue damage by rough aspirationtrop .

I.2 DIFFERENT DRAINS
The most widely used are tubular drains drains , blades, and aspiratifs lesmèches drains . Other systems are sometimes used a bundle of hairs , irrigation system etaspiration or bag Mikulicz .
Figure 1: Drain tubal multiperforated

This is a simple tube template ranging from 2 to 10 mm . He was often rubber cematériau but is irritating to the tissues on contact and causes an inflammatory reaction etadhérentielle not always desired . But it is a material that can be found everywhere, peuonéreux ,

 The blade
The most common is the blade corrugated rubber, very cheap and yet trèsutilisée ; is an exclusively passive drain.

- The simple suction drain
The best known is the Jost- Redon drain , drain small silicone plastic multiperforated OF a end connected to the other end to a pipe and a jar where the vacuum is renouvelérégulièrement .
- The suction drains with air intake
Many models are described . They usually have a central suction tube and an outer or lateral pipe with air intake to avoid lesphénomènes suction abdominal viscera in particular .


- The locks
Make sterile gauze of various sizes , they are usually available in layers superposéesdans the bottom of a cavity.

- Threadlike Drainage: said horsehair "Florence"
Indeed beams are used nylon son
- The dressing
Finally , I recall that in the case of a septic wound left open and dressed flat ( plaiede war for example) , the dressing itself acts as a drain on absorbent
secretions produced locally , provided it is done correctly and renewed.

4. INDICATIONS AND EXAMPLES
Each surgeon and each school has its habits it is not possible to enter ledétail or controversies . I will not give here the usual examples assezgénéralement admitted.
- Abscess of soft parts
After incision and drainage of abscess, a wavy blade is placed through the incision and ressorten sloping area. The incision itself is not closed . The drain is removed after three to cinqjours ( fig. 5 ) .
Figure 5: Drainage of breast abscess by a blade


Direct Route / Route sloping .
- hematoma
After evacuation, a Redon drain is placed and the incision closed.
- Wounds of the soft parts , and recent low contamination
After trimming, the wound is closed in a blade positioned at the wound or incision - unecontre .
- Acute Appendicitis
If abscess or peritonitis , a blade is retained by the outgoing estpartiellement incision closed. It will be mobilized after two to three days and then retiréeprogressivement .
- Gynecological Surgery
Regulated and non-septic ( simple hysterectomy , ovarian cyst , pregnancy extrautérinesimple ) surgery : the drainage is often unnecessary . If we take a Redon is sufficient.
- More complex surgery
Including tank ( pelvic peritonitis ) , effective drainage is necessary : draintubulaire blade and in the cul- de- sac and exiting a cons - incision at lafosse iliac suction drain or bag Mikulicz in severe forms .
- Surgery of the colon and rectum
Drainage here is to avoid the formation of a pelvic hematoma often superinfected which , in contact with the anastomosis , is a factor of disunity and fistula. The drain allows desurveiller accurately the evolution during the first days . If a partial lâchageanastomotique occur, the diagnosis would be facilitated ( on the aspect of dedrainage liquid) and the best prognosis because of the evacuation by the drain of product lafistule . But in this area each surgeon has his own ideas and use as appropriate unsystème aspirative or a blade and a drain. The tendency is to drain dedécollement spaces , often by suction drains or suction drain .

- Biliary Surgery
After a simple cholecystectomy, a Redon drain is sufficient and will be removed after a aTwo days. Case of suppurative or gangrenous cholecystitis with importantsremaniements local inflammation , it will drain readily by multitubulée blade , for example , leaving a sloping against the right flank incision .
If a drain cholelithiasis Kehr , T is placed in the path biliaireprincipale . This drain is usually made ​​of rubber and it must be perfectly fixed pouréviter at all costs inadvertent mobilization the early days. Devradonner the surgeon precise instructions regarding the installation and monitoring of the drain. Unecholangiographie control will be carried out to verify the eighth day for freedom lavoie bile and no residual calculation.

- Perforation of ulcer
First of all, washing the peritoneal cavity must be complete and perfect. Then he esthabituel drain the supramesocolic floor by a suction drain or a blade and leaving a undrain against the right flank incision .

- Generalized peritonitis
After treating the cause and meticulous cleaning of the entire peritoneal cavity to drain areas ons'efforcera usual stagnation (under coupolesdiaphragmatiques the cul-de- sac ) and cruentées abscess and lodges. In cedernier case , drains are removed very slowly so permettrel'affaissement and complete drying of the cavity.

- Orthopaedic Surgery and Traumatology
After surgery , one or more suction drains Redon will be left in the siteopératoire to avoid the formation of hematoma which promote superinfection . Lesprécautions aseptic around the drain here are also very important to avoid infectious unecomplication by the path of the drain , because we know the seriousness of these infections, surtoutlorsque metallic material (plate, nails, prosthesis) was made.

- Thoracic Surgery
Thoracic drainage and drainage of urine ( suprapubic catheterization and trans-urethral survey ) are specific topics that can not be simplified without risk. Cessujets will therefore be subject to special questions.
Thus, according to the use made of a drain can be helpful or harmful. It belongs to the celuiqui laying weigh the indication and technique. Rigorous nursing etéclairés (for explanations necessary ) avoid a lot of trouble to the patient !


MR: OUZMI