Brief Communication: Removal of a Fractured Jackson-Pratt Drain Using Computerized Tomography-Guided Wire Localization

Author(s): 
Steven Davison, MD, DDS;1 Edward Lee, MS;2 Frederick Heckler, MD3

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.[7] 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.[8] In addition, two retained Jackson-Pratt drains have been retrieved using endoscopic techniques, a grasping forceps[9] in one case and a Fogarty balloon[10] 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.[11]

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.

References: 

References

1. Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 16th Edition. Philadelphia, PA: WB Saunders Company, 2001:200–3.
2. Jackson-Pratt Drain Package Insert. Cranston, RI: Davol, 1995.
3. Jansen B, Peters G. Foreign body associated infection. J Antimicrob Chemother 1993;32 (Suppl A):69–75.
4. Pownell PH. Pressure sores. Select Read Plast Surg 1995;7:1–27.
5. Dolzeal R, Cohen M, Schultz RC. The use of clinitron therapy unit in the immediate postoperative care of pressure ulcers. Ann Plast Surg 1985;14:33–6.
6. Delgaudio JM, Dillard DG, Albritton FD, et al. Computed tomography-guided needle biopsy of head and neck lesions. Arch Otholaryngol Head Neck Surg 2000;126:366–70.
7. Hardy JD. Complications in Surgery and Their Management, Fourth Edition. Philadelphia, PA: WB Saunders, 1981:238–9.
8. Leonovicz PF, Uehling DT. Removal of retained penrose drain under fluoroscopic guidance. Urology 1999;53:1221.
9. Morse SS, Kaffenberger DA, Finney NR. Percutaneous retrieval of a fractured surgical drain from the deep perineal soft tissues: Technical note. Cardiovasc Intervent Radiol 1990;13:117–8.
10. Namyslowski J, Halin NJ, Greenfield AJ. Percutaneous retrieval of a retained Jackson-Pratt drain fragment. Cardiovasc Intervent Radiol 1996;19:446–8.
11. Horne SK, Park GC, Dahlen RT, Brennan J. Computerized tomography-guided wire localization: An intraoperative tool for head and neck resections. Arch Otolaryngol Head Neck Surg 2002;128:187–9.



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