Caring for a passive surgical drain
- You have a “passive drain,” so fluid will naturally drain through the early postoperative period from the top hole to one side of your incision. Please keep ample gauze with an ABD pad on top held in place with tight-fitting compression shorts.
- The body naturally accumulates fluid under the flap that was used to reconstruct the buttock area. Since everyone has an abscess under the skin going into surgery, the fluid under the flap also contains some of that infection, so expelling it is crucial.
- The flap is located on the side of the incision where the upper drain hole is positioned.
- Sitting helps to expel fluid, but to ensure most of the fluid is removed, it’s also important to have your helper roll a cigar-shaped piece of gauze up the flap (bottom to top) three times a day while your drain is in place.
- Please also keep a piece of rolled gauze tucked into the lowest portion of your buttock cheeks to help absorb any fluid, prevent chaffing, and allow air to reach the lowest portion of the incision.
- Please remove all gauze dressings (but not the supportive strips) for showering.
- Change the gauze dressings several times a day.
- Please text Dr. Sternberg if the fluid:
- Does not seem to be draining sufficiently and the flap becomes swollen
- Turns an odd color (brown, green) or becomes cloudy
- Has a foul odor
- Is draining directly through the incision in significant quantities rather than through the upper drain hole
- If there is some incisional separation wider than a pencil
What You Need to Do
- Rolling the flap: For the first 3-4 days after surgery and before your helper rolls, have your helper poke the upper hole with a non-sterile Q-tip down a bit and then lower the shaft of the Q Tip and insert it around 1 inch at a shallow angle to make certain that the hole isn’t clogged. Have them roll the Q-Tip in a circular pattern a few times to “dilate” the hole.
- Three times a day for the 8 days your drain will be in, someone will need to roll a cigar-shaped roll of gauze up the flap side (the flap is the side with the superior drain hole) to evacuate fluid from under the flap. Please lie down on a firm surface with your bottom up. Have your drain-helper roll from the bottom to the top side of the flap to encourage fluid to drain through the top hole. Don’t be alarmed if some fluid drains from the top of the incision. Don’t try to milk fluid from the lower drain hole.
- There is no reason to roll on the side opposite the flap. Your helper only needs to roll until most of the fluid stops coming out – usually 3-8 rolls. Leaving a Q-tip inserted 1 inch into the drain hole at a shallow angle under the flap during the rolling procedure may help.
- The drain can be removed on or after day 8 once there is minimal fluid coming from the top hole when rolling gauze up the flap. Before removing the drain (see video), please text Dr. Sternberg a photo of the overnight gauze after you change it in the morning and a photo of your incision. Please don’t remove the drain until he gets back to you.
Caring for a closed-suction surgical drain
During your cleft lift surgery, a closed suction drain was placed to remove the fluid that will accumulate in the potential space under the surgical flap. Here’s how to take care of it:
- Secure the tube and bag inside your clothing with a safety pin or the clip on the bulb if one is present. Please protect the drain as it can easily get caught on objects such as door handles. Tuck it in your pants on place the bulb in your pants pocket. If it’s accidentally removed, it isn’t easy to replace, and it’s important for a smooth recovery.
- Empty your drain at least twice a day into the provided measuring cup and record the fluid volume in CCs/MLs. If there is only a small amount of fluid in the cup you may measure it by drawing up the fluid in the supplied syringe.
- Change the dressing around the tube every day. This is just to protect your clothing in case some fluid leaks around the tube.
- You should remove and replace the dressings when showering but do not remove the Steri-Strips that support the wound. **Photo
- “Stripping” the tube helps prevent blood clots from blocking it. It is best to do this with an alcohol swab or soapy fingers (so your fingers slide). The first 2 inches of the drain is firm, so squeeze the first soft portion.
- Please wash your hands thoroughly before emptying the drain!
- The bulb should be partially compressed at all times. If the bulb is full and round, it does not apply suction and should be re-compressed.
Watch the Video to understand what to do during your early recovery when the drain is in place:
Here is an instructional video about how to care for your drain
Emptying the bulb:
- Get your measuring cup ready.
- Clean your hands well with soap and water or with an alcohol-based cleanser.
- Open the bulb cap.
- Empty the fluid into the measuring cup as CCs/MLs and record the date and the time. If there is only a small amount of fluid in the bulb, you may empty it into the provided cup and measure it by drawing it up in the provided syringe.
- Squeeze the suction bulb and hold it flat.
- While the bulb is squeezed flat, close the cap.
- Flush the fluid down the toilet.
If you need another Closed Suction Drain Output Record (the surgery center will provide you with one), download a PDF with the link provided.
What if there is no fluid draining into the bulb?
If there is no fluid output from the drain during the day of surgery don’t worry and there’s no need to call. You’ll be seeing us in the office the day following surgery and we’ll make sure your drain is functioning properly. Often there is very little fluid coming out initially.
This may mean that there is no more fluid accumulating under the flap, but it could also mean that the drain is clogged. You should strip the drain.
- If you see a blood clot or obstruction in the drain, squeeze the tubing there to help break it up.
- Grip the drain with your fingers, 2 inches from where it exits the body and compress the tube to occlude it. With your other hand squeeze down the length of the tube with an alcohol pad or with soapy fingers (so they slide). Start at the first soft portion of the drain and move toward the drainage bulb. Keep the stripping fingers compressing the tube and release the fingers compressing the tube where it exits your body. Do this several times until fluid is draining into the bulb.
What do I do if my drain appears to have clogged?
If you stripped the drain several times and there is no fluid draining into the bulb, your drain may be clogged. If you notice this the first night after surgery or the morning following surgery, no need to worry because I will unclog your drain in the office on your first postop day appointment.
If this occurs after you have seen me in the office, we will have sent you home with a 5-cc syringe. After washing your hands, please take the tube off of the drain bulb (just pull firmly). Draw 5 cc of air into the syringe and mate it with the end of the drain tube. Inject the air through the drain tube and then pull back on the syringe plunger to see if fluid comes into the tubing. If no fluid comes in take the syringe off and draw 5 cc more of air and inject that into the drain tube again. Then reattach the bulb and squeeze it by taking the white cap of it and squeezing the bulb.
Removing the Closed Suction Drain
The drain needs to stay in place for 8 days after surgery regardless of the output. It is not worth removing it early as if fluid reaccumulates under the flap its a problem.
Please remove the drain after day 8 when the output has been less than 15cc of fluid 2 days in a row. This is generally 8 to 10 days after surgery. If Dr. Sternberg discussed a more stringent criteria with you due to a large abscess or complicated operartion please wait until you hit that mark (usually 10cc/day x 2 day). Please text Dr. Sternberg before doing so and he will confirm that it’s fine.
Removing the drain is simple. Just cut 1 limb of the suture holding the drain to the skin at the skin level and gently pull the drain out. The drain is approximately 15 cm or 7 inches long. It should slide out easily and not hurt.
After the drain is removed, cover the drain hole with a piece of gauze (remove when showering), and switch to a bandaide the next day. Apply petroleum Vaseline twice a day to keep the wound moist and help with healing (a firm scab may delay healing).
You should gently peel off the Steri-Strips 3 days after removing the drain. (Please note that in the video, I removed them when I removed the drain. Please wait 3 days more).
These are SteriStrips, please do not remove them for the first 10 days after surgery or until 3 days after the drain has been removed.
Once the drain is out, cover the hole with a piece of gauze and switch it to a Band-Aide. It may leak a bit for a few days. Then you may can start to gently exercise but for another month please be mindful as you’ve just had a large operation on a delicate area. During this month don’t ride a bike, don’t fall on you backside, or submerge in water. Squats are also not a great idea but lifting weights and walking or running is fine. Please have the patient call or text us a month after drain removal so we know you are good.
How to Remove External Sutures
You likely had several external sutures placed along the lower portion of your incision during surgery to help prevent or minimize any incisional separation as the internal sutures dissolve. These sutures are non-dissolvable and typically should be removed about 3 weeks after surgery.
Before removing them, please text Dr. Sternberg a clear photo of the lower part of your incision and wait for his confirmation.
This is best viewed in full-screen mode to see the thin blue sutures!
- The blue suture is the one supporting the incision.
- You can gently lift either the blue knot (seen at the top of the video) or the black suture (at the bottom of the video) to expose two blue suture strands.
- Cut both blue strands, then pull up on the knot from the opposite side (from where you made the cut). The blue suture should come out in one piece.
Meet Your Surgeon, Dr. Jeffrey Sternberg
After many years performing major abdominal operations including open and laparoscopic resections for colon cancer, rectal cancer, Crohn’s disease, and Ulcerative colitis, I have chosen to concentrate my efforts in a few highly specialized areas of surgery where I feel I can make the greatest positive impact on patients.
More on my Training and Experience
