Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 23.
doi: 10.1007/s00405-025-09713-1. Online ahead of print.

The impact of 4DryField PH on hemostasis and postoperative drain placement in thyroid surgery

Yu-Yang Lin #  1 , Yen-Chen Wu #  2 , Shih-Wei Wang  3   4   5 , Hsin-Yi Tseng  3   5 , Yi-Chu Lin  3   6   5 , Jia Joanna Wang  3   4   5 , Cheng-Hsun Chuang  3   6   5 , Leong-Perng Chan  3   5 , Tzu-Yen Huang  7   8   9 , Che-Wei Wu  3   5
Affiliations

The impact of 4DryField PH on hemostasis and postoperative drain placement in thyroid surgery

Yu-Yang Lin et al. Eur Arch Otorhinolaryngol. .

Abstract

Purpose: Thyroid surgery carries a risk of postoperative hematoma due to rich vascularity, commonly managed by drain placement, potentially increasing hospital stay. 4DryField PH (4DF), a powdered hemostatic material, has been widely used in surgery to improve hemostasis. This study investigates the impact of using 4DF in thyroid surgery on postoperative drainage placement.

Methods: This retrospective study analyzed 208 patients undergoing neuro-monitored and Ligasure-assisted thyroidectomy. Patients were divided into non-hemostatic material and drain (NHM, n = 107), and 4DF groups (n = 101). In the 4DF group, drain placement was determined by intraoperative bloody exudate assessment approximately 30 s after 4DF application, classifying into drain (4DF + D, n = 23) and no-drain (4DF-D, n = 78) groups. Clinical characteristics, drainage volumes, and duration of drain placement were compared between groups.

Results: No significant demographic differences existed between NHM and 4DF groups. Drain placement in 22.8% of the 4DF group, significantly associated with extensive surgery, larger tumor volume, and elevated anti-thyroid antibodies. Despite these higher-risk factors, total drainage volumes were similar between the 4DF + D and NHM groups (34.9 mL vs. 38.8 mL, p = 0.364). Almost all patients in the 4DF + D group (95.7%) had drainage > 20mL. Drainage volumes > 100mL occurred in two NHM group patients (1.9%), but not in the 4DF + D group. All drains in 4DF + D were removed by postoperative day 2.

Conclusion: Using 4DF during thyroid surgery reduced the need for drain placement by identifying high-risk patients through standardized intraoperative exudate assessment. This approach effectively controlled postoperative drainage and appeared helpful in preventing excessive exudate and enabling tailored drain management.

Keywords: 4DryField PH; Hemostasis material; Intraoperative exudate assessment; Postoperative drain placement; Thyroid surgery.

PubMed Disclaimer

Conflict of interest statement

Declarations. Research involving human participants and/or animals: This study was approved by the Ethics Committee (KMUHIRB-E(I)-20240322). Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393(5):667–673. https://doi.org/10.1007/s00423-008-0366-7 - DOI - PubMed
    1. Wojtczak B, Aporowicz M, Kaliszewski K, Bolanowski M (2018) Consequences of bleeding after thyroid surgery - analysis of 7805 operations performed in a single center. Arch Med Sci 14(2):329–335. https://doi.org/10.5114/aoms.2016.63004 - DOI - PubMed
    1. Rosenbaum MA, Haridas M, McHenry CR (2008) Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg 195(3):339–343. https://doi.org/10.1016/j.amjsurg.2007.12.008 - DOI - PubMed
    1. Godballe C, Madsen AR, Pedersen HB, Sorensen CH, Pedersen U, Frisch T et al (2009) Post-thyroidectomy hemorrhage: a National study of patients treated at the Danish departments of ENT head and neck surgery. Eur Arch Otorhinolaryngol 266(12):1945–1952. https://doi.org/10.1007/s00405-009-0949-0 - DOI - PubMed
    1. Lorenz K, Sekulla C, Kern J, Dralle H (2015) [Management of postoperative hemorrhage following thyroid surgery]. Chirurg 86(1):17–23. https://doi.org/10.1007/s00104-014-2818-7 - DOI - PubMed

LinkOut - more resources