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Ann Thorac Surg 2007;83:2258-2259
© 2007 The Society of Thoracic Surgeons

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Correspondence

Use of Flexible Silastic Drains in Thoracic Surgery: A Word of Caution

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA 6009 Australia

(Email: drpankajsaxena{at}hotmail.com).

To the Editor:

We read with great interest the article by Ishikura and coworkers [1]. We would like to point out that this is not the first ever-reported experience with the use of flexible silastic drains after lung resection and other general thoracic surgical procedures. We reported the use of Blake drains (Johnson & Johnson, Somerville, NJ) for drainage of pleural cavity in patients undergoing thoracotomy earlier [2]. We used these drains in 37 patients undergoing various thoracic surgical procedures, mainly lung resections. In our study a single drain was placed in the pleural cavity that was apically secured to the chest wall with a stitch. The fluted portion of drain lies along the length of the pleural cavity. Suction of –5 kPa was applied to the drainage system. This provided an effective drainage after thoracotomy. We agree with the authors that 19-French Blake drains (Johnson & Johnson) provide a number of advantages in this setting. Only the single tube is usually sufficient in comparison with two conventional chest drains; the single tube causes less postoperative pain (possibly because of the small size and flexibility), is more cosmetically attractive, provides effective drainage of fluid and blood from the pleural cavity, and is less painful to remove. This is in contrast to the conventionally used large-sized rigid pleural drains, which may affect the postoperative recovery by limiting ambulation and interfering with effective chest physiotherapy.

Postoperative air leak can be an important issue in patients undergoing wedge resection, in patients with incompletely developed fissures, in the presence of emphysema, in the presence of intrapleural adhesions, or in patients requiring decortication of lung. We do have some concerns about the efficacy of silastic drains in managing postoperative air leaks. Ishikura and colleagues [1] did not raise this issue in their article. In two of our patients an additional standard drain was inserted to manage continued air leak beyond 10 days, which was successful. Both of these patients had bilobectomy involving the right middle and lower lobes. There is a gradual blockage of the drain by fibrinous deposits and hence the efficacy to evacuate air from the pleural cavity can be compromised. Presently we would advocate and use Blake drains only in those patients in whom no extensive dissection of fissures was performed during lung resection and no significant air leak was noticed at the end of the procedure. We also think that the drainage of pleural space after a lower lobectomy is not very effective with a single Blake drain. In these patients the best form of drainage is with two standard drains including a basal drain placed over the diaphragm. We believe that two points are important with these drains. The drain should be secured to the apex to keep the tube in position and suction should also be maintained at all times. These measures improve the evacuation of air from the pleural cavity.

	References

Top References

 

1. Ishikura H, Kimura S. The use of flexible silastic drains after chest surgery: novel thoracic drainage Ann Thorac Surg 2006;81:331-334.[Abstract/Free Full Text]
2. Kejriwal N, Newman MAJ. Use of a single silastic chest drain following thoracotomy: initial evaluation ANZ J Surg 2005;75:710-712.[Medline]

This article has been cited by other articles:

				H. Ishikura and S. Kimura Reply Ann. Thorac. Surg., June 1, 2007; 83(6): 2259 - 2259. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pankaj Saxena Nand Kejriwal Mark A.J. Newman Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Saxena, P. Articles by Newman, M. A.J. Search for Related Content PubMed PubMed Citation Articles by Saxena, P. Articles by Newman, M. A.J. Related Collections Pleura Related Article