When dead space exits following a bite wound, the clinical team worries about fluid accumulation which can lead to poor wound healing and infection as the fluid can provide a nutrient source for bacteria and abscess formation. For this reason we are going to demonstrate placement of a penrose drain which allows passive removal of fluid with fluid removal via capillary action.
In this VETgirl video, the patient was placed under general anesthesia and the area around the wound was clipped and prepped to promote aseptic technique and management of the wound. To place the drain, the most dorsal aspect of the dead space pocket is chosen to tack the wound. The proximal end of the drain is blindly tacked underneath the skin with a non absorbable suture such as Ethilon. As you can see in this video, the hemostat grabs the drain in a specific way to allow a visible free end of the drain so that when you drive the needle under the skin, blindly, you have a landmark – notably the hemostat, which allows the clinician to blindly course the needle through the drain using the ventral aspect of the hemostat as a guide. Once the drain is tacked dorsally, the next step is to provide a suitable location to place the drain on the most ventral aspect to allow gravitational passive removal of fluid.
For demonstration purposes and visualization in this video, the drain is clamped with the hemostat so that the tip of the hemostat is more distal than the drain itself. This allows the clinician to place the hemostat blindly in the ventral wound pocked and use a scalpel to create a stab incision and allow exit of the drain, without accidentally cutting the drain while making the stab incision as you are using the hemostat as a cutting guide. Although the drain was initially coursed on the outside of the wound, this was for demonstration only – the proper placement of the drain is of course under the skin – the video now demonstrating the appropriate placement. The drain is then cut in a diagonal, shorter manner for better fluid flow, and the drain is tacked ventrally followed by final wound closure.
A drain such as this often remains in place for 2-4 days. If there is no notable accumulation of fluid in that time and the incision begins to heal appropriately, the drain is removed in 2-4 days followed by removal of the skin sutures in 10-14 days, at the next recheck ensuring appropriate wound healing.
For more great life-saving advice, check out our other VETgirl online veterinary CE videos!