Brief Communication: Removal of a Fractured Jackson-Pratt Drain Using Computerized Tomography-Guided Wire Localization
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The goals for removal of a retained surgical drain should be removal of the retained segment in toto with minimal disruption of the healing tissue. The tenuous nature of the tissue following flap repair for sacral pressure sores necessitates minimal disruption.
There have been several case reports of fractured drains being removed with minimally invasive techniques. In one report, two fractured Penrose drains were removed from the retroperitoneal space and retrovesical space using fluoroscopic guidance and a surgical hemostat passed through a patent drain tract. In addition, two retained Jackson-Pratt drains have been retrieved using endoscopic techniques, a grasping forceps in one case and a Fogarty balloon in the second case. In this case, neither a fistula nor a patent drain tract was noted, rendering removal via either of the above means unfeasible.
CT-guided wire localization has also been used as an intra-operative tool to guide surgical dissection in the head and neck. In one case report, CT guidance allowed minimal and safe dissection with accurate localization and removal of a suspicious mass adjacent to the carotid artery. The neck had undergone a prior operation and irradiation, making the anatomy uncertain and traditional dissection dangerous. In another report, a foreign body was identified adjacent to the cervical spinal cord. Intra-operative palpation of tissue during “blind” surgical exploration would have endangered the patient. CT-guided wire localization allowed accurate dissection without collateral damage.
In this case, the retained drain segment was easily identified under CT, and a hook wire guide was introduced. The wire guide permitted use of a small 2.5cm access incision while increasing localization accuracy. The patient recovered post-operatively without incident and spent two and a half weeks on the low-pressure bed for a total of six and a half weeks, which was one half of a week more than originally planned. There was no adverse effect on the original flap repair and only a minimal increase in recovery time. This case illustrates an innovative application of a minimally invasive technique.
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