Please cite this article in press as: O. Madgar, O. Segal, J. Mansour, et al.. Closed–suction compared with Penrose drainage after free flap reconstruction in the head and neck. Br J Oral Maxillofac Surg (2019), https://doi.org/10.1016/j.bjoms.2019.10.001 ARTICLE IN PRESS YBJOM-5810; No. of Pages 4 British Journal of Oral and Maxillofacial Surgery xxx (2019) xxx–xxx Available online at www.sciencedirect.com ScienceDirect Closed–suction compared with Penrose drainage after free flap reconstruction in the head and neck O. Madgar a,* , O. Segal b , J. Mansour a , D. Sagiv a,b , A. Dubriyan c , L. Bedrin a , Y.P. Talmi a,b , M. Wolf a,b , E.E. Alon a,b a Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel b Sackler Faculty of Medicine, Tel Aviv University, Israel c Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel Hashomer, Israel Accepted 1 October 2019 Abstract Microsurgical free flaps are common in head and neck reconstruction, and their techniques and outcomes have continuously improved during the past decades. However, there are variations in practice among surgeons between the use of closed-suction drainage systems and Penrose drains. The proponents of Penrose drains propose that the negative pressure generated by the closed-suction drainage system may harm the microvascular anastomosis. We know of no previous studies that have compared the two drains for microvascular free flap reconstruction, so our aim was to compare them in a single-centre, retrospective review of all patients who had microvascular free flap reconstruction of the head and neck region in our department between 1 November 2010 and 1 September 2017. During this period 84 patients had 87 free flap reconstructions in the head and neck, 43 of which had Penrose, and 44 closed-suction, drainage. We compared the number of complications between the groups including haematomas, seromas, wound infections, anastomostic thrombosis, anastomotic revision, and need for re-exploration. There were no significant differences between the groups, despite a trend toward fewer negative explorations in the closed-suction group. There were no differences in complications between suction and passive drainage systems after microvascular free flaps, which suggests that closed suction drainage could be safely used after free flap reconstruction in the head and neck. © 2019 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Microvascular reconstruction; Free flap; Drainage; Post-operative drainage; Penrose drain; Closed-suction drain Introduction Nowadays, microsurgical free flap reconstruction is used in day-to-day practice after resection of head and neck tumours. 1–3 The free flap technique enables the harvest- ing of a large amount of tissue, which can be tailored to reconstruct the defect while simultaneously permitting * Corresponding author at: Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer 52621, Israel. Tel.: +972-3-5302242; Fax: +972-3-5305387. E-mail address: ory.madgar@sheba.health.gov.il (O. Madgar). more extensive oncological resections. 1,4 Selection, tech- niques, and outcomes of free tissue transfer have continuously been improved and refined with experience gained in past decades. 1,3–5 Free flaps give potentially give higher success rates, better functional outcomes, and improved aesthetic results compared with other means of reconstruction. 1,2,4–7 There are variations in practice among surgeons between the use of closed-suction drainage systems and Penrose drainage in the surgical neck wound when reconstructing the defect with free tissue transfer. Surgical drains are placed in dependent areas to prevent possible formation of seromas or early haematomas. Proper drainage after microvascu- https://doi.org/10.1016/j.bjoms.2019.10.001 0266-4356/© 2019 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.