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Abstract online early

A simple, novel technique for fixing Penrose drains in minor surgeries, with advantages for remote outpatient clinics: a retrospective comparison with conventional drain fixation in North Ibaraki, Japan     [ Original Research ]

Submitted: 30 July 2016
Revised: 21 April 2017
Accepted: 9 May 2017

Author(s) : Shibuya Y, Matsumoto G, Sasaki M, Sasaki K, Adachi K, Sekido M.


Introduction: In rural areas with few doctors, surgeons might avoid using Penrose drains in minor surgeries for soft tissue trauma or small subcutaneous tumors, even though the drain would prevent hematoma, because of the limited availability of postsurgical care. While working at a remote outpatient clinic in northern Ibaraki Prefecture, a rural area of Japan with few doctors and even fewer plastic surgeons, a case of mild hematoma that had formed after a minor subcutaneous surgery was experienced. Had the surgery been performed at our university hospital, which is our base of clinical activity, a Penrose drain would have been used to prevent hematoma. However, the remote outpatient clinic is staffed only once a week, and it was not practical to use a Penrose drain, because no doctor would be available to remove it until a week after the surgery. This experience led us to develop a simple fixation method for Penrose drains that can be used even in remote areas, because a doctor does not have to be present to remove the drain. This method has proved effective in our clinical practice. In this article, a retrospective study comparing cases using our new method of fixing Penrose drains and cases in which the Penrose drain was fixed by conventional suturing is presented.
Methods: The medical records of patients who underwent minor surgeries using Penrose drains were reviewed. The surgeries were performed from April 2012 to March 2015 in remote outpatient clinics connected to our affiliated hospitals. The cases were divided into two groups: those using our new method, in which the Penrose drains were sewn onto the wound dressings and could be automatically removed while changing the dressing, and those in which the Penrose drains were conventionally fixed to the skin and removed one or several days after surgery by another doctor at the outpatient clinic. The rates of drain-related complications and of automatic drain removal (i.e.,
removal without a doctor’s assistance) between the two groups were compared.
Results: 54 Penrose drains used for 48 lesions in 44 patients (25 men, 19 women) in our new-method group, and 36 Penrose drains for 25 lesions in 21 patients (12 men, 9 women) in the conventional-method (control) group were analyzed. All 54 Penrose drains in the new-method group were removed automatically, while none of the 36 drains in the control group were removed automatically. There were no drain-related
complications, such as massive hematoma, retrograde infection, seroma, or drain breakage or straying, in any of the new-method or control cases.
Conclusions: Our new Penrose-drain fixation method is safe and is particularly suitable for minor surgeries in rural
areas where there are no resident doctors. The wide use of this method for appropriate minor surgeries in doctorless rural areas has the potential to reduce surgical complications, the time burden for both patients and surgeons, the economic burden on patients and their families, and even public health care costs.

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