CRANIOMAXILLOFACIAL TRAUMA
Usefulness of a Negative Suction Drain for Reducing Postoperative Swelling in a Blowout Fracture Kyoung Mook Lee, MD,* Seung Hyup Choi, MD,y and Jang Hyun Lee, MD, PhDz Purpose:
To identify whether a negative suction drain is more effective than a Penrose drain in the decrease of postoperative swelling from a blowout fracture.
Patients and Methods:
This was a retrospective study of patients who underwent surgical treatment for isolated orbital floor fracture. The population was categorized into 2 groups: one with a Penrose drain and the other with a negative suction drain in the surgical site. To evaluate the degree of swelling, the interlid length was measured. The predictor variable was the type of drain used. The outcome variable was the interlid length at postoperative days 1, 3, 5, and 7. The other study variables were patient characteristics, type of injury, time from injury to surgery, and operative duration. Bivariate, multivariate, and Pearson correlation analyses were used to assess the relation of the postoperative interlid length with the other study variables listed earlier. A generalized linear model was used to determine the relation between the type of drain and the postoperative interlid length.
Results:
Ninety-five patients (45 patients received a Penrose drain and 50 patients received suction drainage) were included for the study. The postoperative interlid length was unrelated to the other study variables (P > .05). The suction drain group had a significantly longer interlid length than the Penrose drain group at every postoperative interval (P < .05).
Conclusion:
The use of closed vacuum drainage in blowout fractures is more effective in the decrease of postoperative swelling than the use of a conventional Penrose drain. Ó 2014 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg -:1-7, 2014
Reduction of facial bone fractures is a major field in maxillofacial surgery. Open reduction of blowout fractures or tripod fractures has been performed frequently in many hospitals around the world. Complications after periorbital bone surgery through a subciliary incision include hematoma formation, ectropion, and even visual loss, which is the most dreaded complication. Visual loss can occur by direct nerve injury during surgery or by compression of the optic nerve by retrobulbar hemorrhage.1 Therefore, to prevent these complications, meticulous
hemostasis during surgery and proper drainage after surgery are very important. Severe postoperative swelling of the periorbital region can mask complications, such as retrobulbar hemorrhage. When excessive hematoma is formed, it can lead to ectropion. To detect and prevent such early complications, the expeditious decrease of postoperative swelling is crucial. In orbital surgery, passive drainage is most commonly used for postoperative surgical site drainage. In some cases, no external drainage of the surgical site is used in orbital surgery at all. In other
*Assistant Professor, Department of Plastic and Reconstructive
Address correspondence and reprint requests to Dr J.H. Lee:
Surgery, Inje University Haeundae Paik Hospital, Inje University
Department of Plastic and Reconstructive Surgery, Hanyang University
College of Medicine, Busan, Korea.
Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, Republic of Ko-
yResident, Department of Plastic and Reconstructive Surgery,
rea; e-mail: [email protected]
Hanyang University Guri Hospital, Hanyang University College of
Received October 30 2013
Medicine, Guri, Korea.
Accepted February 17 2014
zAssistant Professor, Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University
Ó 2014 American Association of Oral and Maxillofacial Surgeons
College of Medicine, Guri, Korea.
http://dx.doi.org/10.1016/j.joms.2014.02.032
0278-2391/14/00243-2$36.00/0
This study was supported by the research fund of Hanyang University (HY-2014).
1
2
NEGATIVE SUCTION DRAIN IN BLOWOUT FRACTURE
surgical specialties, such as general surgery and orthopedic surgery, closed negative pressure drainage in the surgical site is used frequently.2,3 The authors placed a closed suction drain in the surgical site during blowout fracture surgery based on this idea and compared the outcomes with those of passive drainage used previously for the effectiveness of decreasing postoperative swelling. The purpose of this study was to confirm the benefit of negative suction drainage for decreasing postoperative swelling after surgical reduction of a blowout fracture. The authors hypothesized that postoperative swelling in the group with a negative suction drain would be less severe than that in the group with the passive drain. The specific aims of the study were to 1) measure the distance between the upper and lower lid margins to estimate postoperative swelling after surgical correction of a blowout fracture and 2) compare the interlid length in the group with a negative suction drain with that in the group with a passive Penrose drain.
Patients and Methods STUDY DESIGN AND SAMPLE
To verify the hypothesis, the authors organized a retrospective study, which was approved by the institutional review board of Hanyang University Guri Hospital (IRB No. 2013-20), and all participants signed an informed consent agreement. The study population was composed of patients who presented to the Department of Plastic and Reconstructive Surgery at Hanyang University Guri Hospital for management of isolated orbital floor fractures from January 2010 to May 2013. All patients eligible for study inclusion had isolated orbital floor fracture who underwent operative treatment of the fracture and were treated with a suction drain or a Penrose drain after surgery. Patients who were excluded from study enrollment were those with concomitant medial orbital wall fractures, infraorbital rim fractures, or other multiple facial bone fractures; those in whom it was impossible to measure the distance between the upper and lower lid margins owing to central nervous system injury; and those who refused study enrollment. Surgery was performed after significant resolution of preoperative periorbital swelling. A subciliary approach was used for all blowout fracture cases, 2 mm below the lash line, and the skin flap was dissected to the lower margin of the tarsal plate. Then, the skin-orbicularis oculi muscle flap was dissected to the arcus marginalis. After exposure of the orbital rim, subperiosteal dissection at the orbital floor was performed to find the site of the fracture followed by reduction of the herniated soft tissue. A
porous polyethylene was designed to cover the site of the fracture and was inserted into the fracture site to prevent reherniation of the soft tissue. Evaluation of periorbital swelling was performed by measuring the distance (i.e., interlid length) between the upper and lower eyelid margins at the center of the pupil in primary gaze in a sitting position (Fig 1). The measurement was performed twice to produce an average value, which was used for the study. STUDY VARIABLES
The primary predictor variable was the type of drain inserted in the operation site. The population was divided into 2 groups according to the type of drain that had been inserted during surgery (Penrose drain or suction catheter). The authors had inserted a passive Penrose drain in most blowout fracture operations performed before and during 2011; that is, before they invented the negative suction drain for blowout fracture surgery in 2012. The authors have preferred suction drainage since then. In one group, the proximal tip of a Penrose drain was inserted on the inset porous polyethylene implant, and the distal tip was drained out through the lateral site of the subciliary incision. In the other group, the distal tip also was placed on the implant, with several small holes at the distal portion of the catheter for negative suction of the surgical site. The proximal tip was placed outside through the lateral site of the subciliary incision, and a 17-gauge injection needle was connected to the distal end of the catheter. Then, a vacuum tube (BD Vacutainer, Becton Dickinson, Franklin Lakes, NJ) was connected to the injection needle for active negative pressure drainage (Fig 2). The amount of drainage from the vacuum tube was measured daily. The authors also checked the date of removal of the 2 drain types. These procedures were performed by a single surgeon with 10 years of experience in reduction of blowout fractures. Wound dressing was performed to enclose the Penrose drain or negative suction drain. The outcome variable was interlid length at postoperative days 1, 3, 5, and 7 on the injured side. Other variables included patient characteristics (age and gender), type of injury (fall, assault, work-related injury, sports-related injury, or traffic accident), elapsed time from injury to surgery, and operation duration. DATA ANALYSIS
Data were abstracted from the retrospective chart review. Bivariate and multivariate analyses were performed to measure the association between all study variables (age, gender, type of injury, elapsed time from injury to surgery, and operation duration)
3
LEE, CHOI, AND LEE
FIGURE 1. This image shows the method of measuring the interlid length. The yellow line is a midpupillary line and the red arrow indicates the interlid length. Lee, Choi, and Lee. Negative Suction Drain in Blowout Fracture. J Oral Maxillofac Surg 2014.
and type of drain and the association between certain study variables (gender and type of injury) and the interlid length. Pearson correlation analysis was performed to determine the relation between the continuous study variables (age, time from injury to surgery, and operative duration) and the interlid length. A generalized linear model (multivariate analysis of variance) was used to determine the association of the interlid length with the 2 different drain types over time. Statistical analysis was performed using SPSS 18.0 (SPSS, Inc, Chicago, IL). A P value less than .05 was considered statistically significant.
from 2012 to 2013. The patients who received a Penrose drain were classified as group I, and the patients who received a suction drain were classified as group II. Table 1 presents the bivariate associations between the variables studied and the type of drain that was used in the blowout fracture operation. The correlations between all study variables and the type of drain were not statistically significant (P > .05). Table 2 presents the association between the variables studied and the interlid length on preoperative day 1 and postoperative days 1, 3, 5, and 7. The correlations between all study variables and the interlid length over time were not statistically significant (P > .05). The results of multivariate analysis of
Results Ninety-five patients were included in this study; in 45 patients a Penrose drain was used after the reduction of blowout fracture from 2010 to 2011, and 50 patients underwent insertion of a suction drain
Table 1. DEMOGRAPHIC, PREOPERATIVE, AND OPERATIVE CHARACTERISTICS BY TYPE OF DRAIN
Variable
Penrose Drain
Suction Drain
Sample size (n = 95) 45 (47.4) 50 (52.6) Men 31 (68.9) 29 (58.0) Types of injury Fall (mechanical) 14 (31.1) 16 (32.0) Traffic accident 6 (13.3) 8 (16.0) Assault 21 (46.7) 20 (40.0) Sports-related injury 4 (8.9) 4 (8.0) Work-related injury 0 2 (4.0) Age (yr) 41.5 14.8 47.1 17.0 Time from injury to 8.5 2.3 8.0 3.2 surgery (days) Operative duration 74.8 21.1 74.1 23.6 (minutes)
P Value
.272y
.702y .90* .394* .884*
FIGURE 2. Closed suction drain system using a vacuum tube.
Note: Data are presented as number (percentage) or mean standard deviation. * By t test. y By c2 test.
Lee, Choi, and Lee. Negative Suction Drain in Blowout Fracture. J Oral Maxillofac Surg 2014.
Lee, Choi, and Lee. Negative Suction Drain in Blowout Fracture. J Oral Maxillofac Surg 2014.
4
NEGATIVE SUCTION DRAIN IN BLOWOUT FRACTURE
Table 2. INTERLID LENGTH OVER TIME ACCORDING TO DEMOGRAPHIC, PREOPERATIVE, AND OPERATIVE CHARACTERISTICS
Interlid Length (mm) Variable Gender Men (n = 60) Women (n = 35) Types of injury Fall (n = 30) Traffic accident (n = 14) Assault (n = 41) Sports-related injury (n = 8) Work-related injury (n = 2) Age Time from injury to surgery Operative duration
PRED 1
POD 1
POD 3
POD 5
POD 7
P Value
8.7 0.5 8.6 0.5y
7.1 0.6 7.1 0.6y
7.5 0.6 7.4 0.7y
8.1 0.6 8.0 0.6y
8.5 0.5 8.4 0.6y
>.05y
8.7 0.5 8.6 0.4 8.6 0.6 8.8 0.6 8.9 0.1z
7.1 0.6 7.3 0.6 7.1 0.6 7.1 0.7 7.5 0.5z
7.4 0.7 7.6 0.6 7.3 0.6 7.5 0.6 7.7 0.3z
8.1 0.6 8.1 0.6 8.0 0.6 8.3 0.6 8.5 0.0z
8.5 0.6 8.4 0.6 8.4 0.6 8.7 0.6 8.7 0.0z
>.05z >.05* >.05* >.05*
Note: Values are presented as mean standard deviation. Abbreviations: POD, postoperative day; PRED, preoperative day. * By Pearson correlation analysis. y By t test. z By analysis of variance. Lee, Choi, and Lee. Negative Suction Drain in Blowout Fracture. J Oral Maxillofac Surg 2014.
variance examining the interlid length over time according to the type of drain are presented in Table 3. The differences in the postoperative interlid length and the adjusted postoperative interlid length between the 2 groups at every postoperative interval were statistically significant (P < .05). The postoperative interlid length of group II was longer than that of group I, and then a lesser degree of postoperative swelling was seen in the patients in group II at all postoperative days assessed.
The average date of drain removal was postoperative day 1.8 0.69 in group I and postoperative day 1.8 0.76 in group II, which showed no significant difference between the 2 groups (P = .54). The average amount of total fluid drained inside the vacuum tube of group II was 3.3 0.54 mL (Fig 3). There were no significant complications, such as hematoma formation, ectropion, or blindness, in any patient. No systemic steroid injection was administered to any patient.
Table 3. INTERLID LENGTH OVER TIME BY TYPE OF DRAIN FOR PATIENTS WHO UNDERWENT OPERATIVE TREATMENT OF BLOWOUT FRACTURE
Interlid Length (mm)* Group Penrose drain (n = 45) Suction drain (n = 50)
PRED 1
POD 1
POD 3
POD 5
POD 7
P Value
8.6 0.5 8.7 0.5
7.0 0.6 7.3 0.5z
7.2 0.6 7.6 0.5z
7.9 0.5 8.2 0.6z
8.4 0.5 8.5 0.6z
Usefulness of a Negative Suction Drain for Reducing Postoperative Swelling in a Blowout Fracture Kyoung Mook Lee, MD,* Seung Hyup Choi, MD,y and Jang Hyun Lee, MD, PhDz Purpose:
To identify whether a negative suction drain is more effective than a Penrose drain in the decrease of postoperative swelling from a blowout fracture.
Patients and Methods:
This was a retrospective study of patients who underwent surgical treatment for isolated orbital floor fracture. The population was categorized into 2 groups: one with a Penrose drain and the other with a negative suction drain in the surgical site. To evaluate the degree of swelling, the interlid length was measured. The predictor variable was the type of drain used. The outcome variable was the interlid length at postoperative days 1, 3, 5, and 7. The other study variables were patient characteristics, type of injury, time from injury to surgery, and operative duration. Bivariate, multivariate, and Pearson correlation analyses were used to assess the relation of the postoperative interlid length with the other study variables listed earlier. A generalized linear model was used to determine the relation between the type of drain and the postoperative interlid length.
Results:
Ninety-five patients (45 patients received a Penrose drain and 50 patients received suction drainage) were included for the study. The postoperative interlid length was unrelated to the other study variables (P > .05). The suction drain group had a significantly longer interlid length than the Penrose drain group at every postoperative interval (P < .05).
Conclusion:
The use of closed vacuum drainage in blowout fractures is more effective in the decrease of postoperative swelling than the use of a conventional Penrose drain. Ó 2014 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg -:1-7, 2014
Reduction of facial bone fractures is a major field in maxillofacial surgery. Open reduction of blowout fractures or tripod fractures has been performed frequently in many hospitals around the world. Complications after periorbital bone surgery through a subciliary incision include hematoma formation, ectropion, and even visual loss, which is the most dreaded complication. Visual loss can occur by direct nerve injury during surgery or by compression of the optic nerve by retrobulbar hemorrhage.1 Therefore, to prevent these complications, meticulous
hemostasis during surgery and proper drainage after surgery are very important. Severe postoperative swelling of the periorbital region can mask complications, such as retrobulbar hemorrhage. When excessive hematoma is formed, it can lead to ectropion. To detect and prevent such early complications, the expeditious decrease of postoperative swelling is crucial. In orbital surgery, passive drainage is most commonly used for postoperative surgical site drainage. In some cases, no external drainage of the surgical site is used in orbital surgery at all. In other
*Assistant Professor, Department of Plastic and Reconstructive
Address correspondence and reprint requests to Dr J.H. Lee:
Surgery, Inje University Haeundae Paik Hospital, Inje University
Department of Plastic and Reconstructive Surgery, Hanyang University
College of Medicine, Busan, Korea.
Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, Republic of Ko-
yResident, Department of Plastic and Reconstructive Surgery,
rea; e-mail: [email protected]
Hanyang University Guri Hospital, Hanyang University College of
Received October 30 2013
Medicine, Guri, Korea.
Accepted February 17 2014
zAssistant Professor, Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University
Ó 2014 American Association of Oral and Maxillofacial Surgeons
College of Medicine, Guri, Korea.
http://dx.doi.org/10.1016/j.joms.2014.02.032
0278-2391/14/00243-2$36.00/0
This study was supported by the research fund of Hanyang University (HY-2014).
1
2
NEGATIVE SUCTION DRAIN IN BLOWOUT FRACTURE
surgical specialties, such as general surgery and orthopedic surgery, closed negative pressure drainage in the surgical site is used frequently.2,3 The authors placed a closed suction drain in the surgical site during blowout fracture surgery based on this idea and compared the outcomes with those of passive drainage used previously for the effectiveness of decreasing postoperative swelling. The purpose of this study was to confirm the benefit of negative suction drainage for decreasing postoperative swelling after surgical reduction of a blowout fracture. The authors hypothesized that postoperative swelling in the group with a negative suction drain would be less severe than that in the group with the passive drain. The specific aims of the study were to 1) measure the distance between the upper and lower lid margins to estimate postoperative swelling after surgical correction of a blowout fracture and 2) compare the interlid length in the group with a negative suction drain with that in the group with a passive Penrose drain.
Patients and Methods STUDY DESIGN AND SAMPLE
To verify the hypothesis, the authors organized a retrospective study, which was approved by the institutional review board of Hanyang University Guri Hospital (IRB No. 2013-20), and all participants signed an informed consent agreement. The study population was composed of patients who presented to the Department of Plastic and Reconstructive Surgery at Hanyang University Guri Hospital for management of isolated orbital floor fractures from January 2010 to May 2013. All patients eligible for study inclusion had isolated orbital floor fracture who underwent operative treatment of the fracture and were treated with a suction drain or a Penrose drain after surgery. Patients who were excluded from study enrollment were those with concomitant medial orbital wall fractures, infraorbital rim fractures, or other multiple facial bone fractures; those in whom it was impossible to measure the distance between the upper and lower lid margins owing to central nervous system injury; and those who refused study enrollment. Surgery was performed after significant resolution of preoperative periorbital swelling. A subciliary approach was used for all blowout fracture cases, 2 mm below the lash line, and the skin flap was dissected to the lower margin of the tarsal plate. Then, the skin-orbicularis oculi muscle flap was dissected to the arcus marginalis. After exposure of the orbital rim, subperiosteal dissection at the orbital floor was performed to find the site of the fracture followed by reduction of the herniated soft tissue. A
porous polyethylene was designed to cover the site of the fracture and was inserted into the fracture site to prevent reherniation of the soft tissue. Evaluation of periorbital swelling was performed by measuring the distance (i.e., interlid length) between the upper and lower eyelid margins at the center of the pupil in primary gaze in a sitting position (Fig 1). The measurement was performed twice to produce an average value, which was used for the study. STUDY VARIABLES
The primary predictor variable was the type of drain inserted in the operation site. The population was divided into 2 groups according to the type of drain that had been inserted during surgery (Penrose drain or suction catheter). The authors had inserted a passive Penrose drain in most blowout fracture operations performed before and during 2011; that is, before they invented the negative suction drain for blowout fracture surgery in 2012. The authors have preferred suction drainage since then. In one group, the proximal tip of a Penrose drain was inserted on the inset porous polyethylene implant, and the distal tip was drained out through the lateral site of the subciliary incision. In the other group, the distal tip also was placed on the implant, with several small holes at the distal portion of the catheter for negative suction of the surgical site. The proximal tip was placed outside through the lateral site of the subciliary incision, and a 17-gauge injection needle was connected to the distal end of the catheter. Then, a vacuum tube (BD Vacutainer, Becton Dickinson, Franklin Lakes, NJ) was connected to the injection needle for active negative pressure drainage (Fig 2). The amount of drainage from the vacuum tube was measured daily. The authors also checked the date of removal of the 2 drain types. These procedures were performed by a single surgeon with 10 years of experience in reduction of blowout fractures. Wound dressing was performed to enclose the Penrose drain or negative suction drain. The outcome variable was interlid length at postoperative days 1, 3, 5, and 7 on the injured side. Other variables included patient characteristics (age and gender), type of injury (fall, assault, work-related injury, sports-related injury, or traffic accident), elapsed time from injury to surgery, and operation duration. DATA ANALYSIS
Data were abstracted from the retrospective chart review. Bivariate and multivariate analyses were performed to measure the association between all study variables (age, gender, type of injury, elapsed time from injury to surgery, and operation duration)
3
LEE, CHOI, AND LEE
FIGURE 1. This image shows the method of measuring the interlid length. The yellow line is a midpupillary line and the red arrow indicates the interlid length. Lee, Choi, and Lee. Negative Suction Drain in Blowout Fracture. J Oral Maxillofac Surg 2014.
and type of drain and the association between certain study variables (gender and type of injury) and the interlid length. Pearson correlation analysis was performed to determine the relation between the continuous study variables (age, time from injury to surgery, and operative duration) and the interlid length. A generalized linear model (multivariate analysis of variance) was used to determine the association of the interlid length with the 2 different drain types over time. Statistical analysis was performed using SPSS 18.0 (SPSS, Inc, Chicago, IL). A P value less than .05 was considered statistically significant.
from 2012 to 2013. The patients who received a Penrose drain were classified as group I, and the patients who received a suction drain were classified as group II. Table 1 presents the bivariate associations between the variables studied and the type of drain that was used in the blowout fracture operation. The correlations between all study variables and the type of drain were not statistically significant (P > .05). Table 2 presents the association between the variables studied and the interlid length on preoperative day 1 and postoperative days 1, 3, 5, and 7. The correlations between all study variables and the interlid length over time were not statistically significant (P > .05). The results of multivariate analysis of
Results Ninety-five patients were included in this study; in 45 patients a Penrose drain was used after the reduction of blowout fracture from 2010 to 2011, and 50 patients underwent insertion of a suction drain
Table 1. DEMOGRAPHIC, PREOPERATIVE, AND OPERATIVE CHARACTERISTICS BY TYPE OF DRAIN
Variable
Penrose Drain
Suction Drain
Sample size (n = 95) 45 (47.4) 50 (52.6) Men 31 (68.9) 29 (58.0) Types of injury Fall (mechanical) 14 (31.1) 16 (32.0) Traffic accident 6 (13.3) 8 (16.0) Assault 21 (46.7) 20 (40.0) Sports-related injury 4 (8.9) 4 (8.0) Work-related injury 0 2 (4.0) Age (yr) 41.5 14.8 47.1 17.0 Time from injury to 8.5 2.3 8.0 3.2 surgery (days) Operative duration 74.8 21.1 74.1 23.6 (minutes)
P Value
.272y
.702y .90* .394* .884*
FIGURE 2. Closed suction drain system using a vacuum tube.
Note: Data are presented as number (percentage) or mean standard deviation. * By t test. y By c2 test.
Lee, Choi, and Lee. Negative Suction Drain in Blowout Fracture. J Oral Maxillofac Surg 2014.
Lee, Choi, and Lee. Negative Suction Drain in Blowout Fracture. J Oral Maxillofac Surg 2014.
4
NEGATIVE SUCTION DRAIN IN BLOWOUT FRACTURE
Table 2. INTERLID LENGTH OVER TIME ACCORDING TO DEMOGRAPHIC, PREOPERATIVE, AND OPERATIVE CHARACTERISTICS
Interlid Length (mm) Variable Gender Men (n = 60) Women (n = 35) Types of injury Fall (n = 30) Traffic accident (n = 14) Assault (n = 41) Sports-related injury (n = 8) Work-related injury (n = 2) Age Time from injury to surgery Operative duration
PRED 1
POD 1
POD 3
POD 5
POD 7
P Value
8.7 0.5 8.6 0.5y
7.1 0.6 7.1 0.6y
7.5 0.6 7.4 0.7y
8.1 0.6 8.0 0.6y
8.5 0.5 8.4 0.6y
>.05y
8.7 0.5 8.6 0.4 8.6 0.6 8.8 0.6 8.9 0.1z
7.1 0.6 7.3 0.6 7.1 0.6 7.1 0.7 7.5 0.5z
7.4 0.7 7.6 0.6 7.3 0.6 7.5 0.6 7.7 0.3z
8.1 0.6 8.1 0.6 8.0 0.6 8.3 0.6 8.5 0.0z
8.5 0.6 8.4 0.6 8.4 0.6 8.7 0.6 8.7 0.0z
>.05z >.05* >.05* >.05*
Note: Values are presented as mean standard deviation. Abbreviations: POD, postoperative day; PRED, preoperative day. * By Pearson correlation analysis. y By t test. z By analysis of variance. Lee, Choi, and Lee. Negative Suction Drain in Blowout Fracture. J Oral Maxillofac Surg 2014.
variance examining the interlid length over time according to the type of drain are presented in Table 3. The differences in the postoperative interlid length and the adjusted postoperative interlid length between the 2 groups at every postoperative interval were statistically significant (P < .05). The postoperative interlid length of group II was longer than that of group I, and then a lesser degree of postoperative swelling was seen in the patients in group II at all postoperative days assessed.
The average date of drain removal was postoperative day 1.8 0.69 in group I and postoperative day 1.8 0.76 in group II, which showed no significant difference between the 2 groups (P = .54). The average amount of total fluid drained inside the vacuum tube of group II was 3.3 0.54 mL (Fig 3). There were no significant complications, such as hematoma formation, ectropion, or blindness, in any patient. No systemic steroid injection was administered to any patient.
Table 3. INTERLID LENGTH OVER TIME BY TYPE OF DRAIN FOR PATIENTS WHO UNDERWENT OPERATIVE TREATMENT OF BLOWOUT FRACTURE
Interlid Length (mm)* Group Penrose drain (n = 45) Suction drain (n = 50)
PRED 1
POD 1
POD 3
POD 5
POD 7
P Value
8.6 0.5 8.7 0.5
7.0 0.6 7.3 0.5z
7.2 0.6 7.6 0.5z
7.9 0.5 8.2 0.6z
8.4 0.5 8.5 0.6z
