Negative versus neutral drainage systems in patients following head and neck surgery- A randomised control study

Surgical drains are now a routine part of postoperative management in major head and neck surgeries. Based on their mechanism of action, drains are broadly classified into negative pressure (active suction) systems and neutral pressure (passive or gravity-based) systems. While negative suction drains are considered effective in reducing fluid collections, minimising dead space, and possibly decreasing infection risk, their application in complex oral cancer surgeries—where tissue integrity is delicate and direct communication with the aero-digestive tract is common—remains debatable. In surgeries involving communication between the oral cavity and neck, or where only thin tissue layers separate compartments, negative pressure drains may pose risks such as tissue compression, microvascular compromise, and suture line dehiscence. Our study aims to address this gap by comparing postoperative hospital course and outcomes in two groups of patients managed with either negative or neutral drainage systems