Surgical Science, 2013, 4, 277-282 http://dx.doi.org/10.4236/ss.2013.45054 Published Online May 2013 (http://www.scirp.org/journal/ss) Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital Ikpeme A. Ikpeme 1* , Ngim E. Ngim 1 , Iniabasi U. Ilori 2 , Enembe Oku 3 , Anthony M. Udosen 1 1 Departments of Orthopaedics & Traumatology, University of Calabar Teaching Hospital, Calabar, Nigeria 2 Departments of Anaesthesiology, University of Calabar Teaching Hospital, Calabar, Nigeria 3 Departments of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria Email: * iaikpeme@yahoo.com Received March 12, 2013; revised April 14, 2013; accepted April 23, 2013 Copyright © 2013 Ikpeme A. Ikpeme et al. This is an open access article distributed under the Creative Commons Attribution Li- cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Surgical wound drainage is practiced routinely by many orthopaedic surgeons despite studies that chal- lenge the practice. Among proponents, the advantages of drainage include prevention of haematoma and/or seroma formation which potentially reduces the chances for infection, prevention of wound swelling, prevention of compart- ment syndrome and improvement of the local wound environment. Opponents argue that prophylactic wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy. Aim: To ascertain if prophylactic drainage of clean orthopaedic wounds confer any significant ad- vantages by evaluating wound and systemic factors in two treatment groups. Patients and Methods: A prospective analysis of 62 patients was undergoing clean orthopaedic procedures. The patients were randomly assigned to a “No drain” (study) group and a “drain” (control) group. Each group had 31 patients. Surgeons were blinded to the randomi- zation process and the evaluation of clinical outcomes. The parameters assessed included pain, superficial wound infec- tion, the need for post-operative transfusion, wound leakage, dressing changes and the surgery-discharge interval. Data was analysed using SPSS statistics version 20 (IBM Corp., New York). Results: There were no significant differences in the demographic data. Femoral fractures were the commonest indication for surgery (43.55%), and plate and screw osteosynthesis was the commonest procedure (48.4% in the drain group and 67.7% in the no-drain group). There was a significantly higher need for post-operative transfusion in the drain group (22.6% against 0%) as well as a significantly prolonged capillary refill time (2.39 + 0.56 secs versus 2.03 + 0.41 secs). Although not statistically significant, there were four cases (12.8%) of superficial wound infection in the drain group and 1 case (3.2%) in the no-drain group. Conclusion: Prophylactic wound drainage confers no significant advantages over no drainage and may contribute to increased treatment costs through an increased post-operative transfusion requirements. Keywords: Wound Drain; No-Drain; Complications; Orthopaedics 1. Introduction Surgical drainage has a long history with Hippocrates (400-377BC) credited with the earliest recorded use of drains as a therapeutic technique [1]. Ambrose Pare (1510-1590) is credited with the wide use of drains in Orthopaedics [1,2]. Surgical drains and drainage tech- niques have evolved over time. Despite studies that chal- lenge the efficacy of prophylactic drainage after clean orthopaedic procedures, prophylactic wound drainage continues to be practiced even with lack of clear evi- dence that they improve outcomes [1,3-5]. The paucity of randomized controlled trials has not helped clinicians arrive at a definitive evidence-based position on the sub- ject [5,6]. The usual documented advantages of prophylactic wound drainage include prevention of haematomas/sero- mas and hence reduction of the risk of infections, pre- vention of wound swelling and compartment syndrome, and improvement of the local wound environment which should lead to improved wound healing [1]. The counter argument is that drains may serve as a conduit for organ- isms and predispose clean wounds to infection. They * Corresponding author. Copyright © 2013 SciRes. SS