Discard little, learn more: the real tissue training model.
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Biomedical subjects
Publications and source records attributed to Wayne Jaffe.
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BACKGROUND: For some patients, removal of surgical drains can be the most painful part of surgery. The authors present a prospective, randomized, patient-controlled study comparing soft fluted silicone (Blake) drains with conventional rigid (Portavac) drains. METHODS: After ethical committee approval, 43 patients undergoing bilateral breast reduction surgery were recruited into the study. A Blake drain was inserted on one side and a Portavac drain was inserted on the contralateral side; the patients therefore acted as their own controls. Pain scores were measured on a descriptive scale 10 minutes before, during, and 10 minutes after drain removal. Statistical analysis was carried out using the Wilcoxon signed ranks matched pairs test. RESULTS: The results show that Blake drains are less painful before (p = 0.05), during (p = 0.01), and after removal (p = 0.009). Of those patients who expressed a preference, 27 preferred the Blake drain and 10 preferred the Portavac drain. CONCLUSION: The authors advocate the use of a silicone fluted (Blake) drain for any wound requiring drainage, especially if large-caliber drains are indicated.
The blood supply of 17 free flaps was studied several months after surgery. The aim was to see whether or not the free flaps acquired blood flow through vessels across the flap inset independently of the main vascular anastomoses. A color Doppler flowmeter was used to identify the original arterial and venous anastomoses, the vessels in the margin of the flap, and also across the flap inset. The main vascular pedicle was then manually compressed for 2 min and blood flow was again examined in the vessels at the margin of the flap. The flap vessels (post-anastomotic), the anastomoses, and the recipient vessels (pre-anastomotic) could be identified in every case. There was no evidence of anastomotic stenosis. No vessels (neo-vascularization) greater than 0.5 mm could be identified across the flap inset. Small arteries could be identified in the flap near the inset. These vessels emptied completely on manual compression of the vascular pedicle for 2 min and did not refill until the compression was released. This evidence suggests that the free flaps do not receive significant blood flow through vessels across the flap inset, and are therefore significantly dependent for vascularity on the original anastomoses even 1 year after surgery.
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