Timing of Drain and Wound VAC Removal After Abdominal Large Ventral Hernia Repair

General Principles for Drain Removal

Drains should be removed as early as possible postoperatively to reduce drainage time, length of hospital stay, and risk of infection 2, 1
Prolonged drainage is associated with increased risk of surgical site infections and longer hospitalization 3
Routine prophylactic use of intra-abdominal surgical drains is generally discouraged in clean and clean-contaminated cases due to lack of evidence supporting their benefit 4, 3

Remove drains when drainage is serous and daily output has decreased to less than 30-50 mL/24 hours 1
Evidence suggests that drain removal is safe when fluid drainage is less than 300 mL/24h compared to waiting for drainage less than 100 mL/24h 5, 1
For surgical drains after abdominal procedures, removal should not be delayed beyond 7-14 days even if output remains higher than target levels 2

Wound VACs should be removed when adequate granulation tissue has formed over the surgical site 6
For grade 4 open abdominal wounds, NPWT can be used until sufficient granulation tissue has formed to support split thickness skin grafting 6
The use of a wound contact layer is recommended between the NPWT wound filler and the wound bed to prevent damage during dressing changes 6
Wound VACs placed through subcutaneous tunnels should be removed as soon as possible, not surpassing 7-14 days of use 2

Daily assessment of drain output: if output is less than 30-50 mL/day of serous fluid, remove drain 1
If output remains high but drain has been in place for >7-14 days, consider removal to reduce infection risk 2
Wound VAC assessment: evaluate granulation tissue formation and remove wound VAC when adequate granulation tissue covers the surgical site 6
If wound VAC has been in place >14 days, consider removal regardless of wound status to reduce infection risk 2

Increased risk of surgical site infections is associated with prolonged drainage 3