Chest drains: purse string suture 4.0
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Chest drains: purse string suture 4.0 Stephanie Rauch1 · André E. Dutly1 Received: 16 December 2019 / Accepted: 1 February 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract There are many discussions about the technique of removal of chest drains. In our hospital, we have used an intracutaneous suture technique with non-absorbable suture material for the purse-string suture for a few years now. Thus the cosmetic results improved considerably. Nevertheless, the thread has to be removed after 10–14 days. To further improve patient comfort we developed a purse-string suture technique using an absorbable barbed suture. We noticed better cosmetic results and less painfull drain removal. Furthermore, there is no more need for a stitch removal which reduces material costs and also pain. Keywords Purse-string suture · Thoracic drain · Pain · Cosmetic result
Introduction There are many discussions about the technique of removal of chest drains. Whether during inspiration or expiration, which type of skin closure, and even the type of the final bandage applied. In the early days of chest drains unguent disinfectant was used to get a hermetically sealed wound. Today most techniques involve a purse string suture applied during surgery. The chest drain removal remains still a painful procedure; on the one hand due to the friction on the parietal pleura, on the other hand due to knotting of the purse-string suture. In our hospital we have used an intracutaneous suture technique with non-absorbable suture material (Prolene 4-0) for the purse-string suture for a few years now. Thus the cosmetic results improved considerably. Nevertheless the thread has to be removed after 10–14 days. To further improve patient comfort we developed the following pursestring suture technique: Using an absorbable barbed suture (V-Loc 4-0, Medtronic), a purse-string suture with two intracutaneous stitches is placed. A third stitch is added to secure the suture and the thread is not shortened (Fig. 1). When removing the tube the long left thread is pulled softly until
the drainage site is totally closed (Fig. 2). The procedure is completed by cutting the thread at skin level, so there is no need for removal of the suture material (Fig. 3). We were astonished by the patient’s reaction. The chest drain removal was much less painful. As a result, we postulate that pain is caused mainly by knotting the purse-string suture and less by friction of the parietal pleura. The positive aspects are the better cosmetic result and less painful drain removal. Furthermore, there is no more need for a stitch removal which reduces material costs and also pain. The disadvantage of this technique is the higher cost of the suture material.
Conclusion Using an absorbable barbed suture for an intracutaneous purse-string suture for thoracic drain insertion the cosmetic results and pain caused by drain removal improve significantly. Stitch removal is no longer necessary.
* Stephanie Rauch [email protected] 1
Department of Thorac
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