Dangers of a tight head dressing

Are head bandages really required after middle-ear surgery? A systematic review

Objective:

A systematic review was performed to evaluate the role and effectiveness of head bandages after routine elective middle-ear surgery.

Methods:

Studies that compared the effectiveness of head bandage use after elective middle-ear surgery (e.g. myringoplasty, mastoidectomy and cochlear implantation) were identified using the following databases: Ovid Medline and Embase, the Ebsco collections, the Cochrane Library, PubMed, and Google Scholar. An initial search identified 71 articles. All titles and abstracts were reviewed. Thirteen relevant articles were inspected in more detail; of these, only five met the inclusion criteria. These included three randomised, controlled trials, one retrospective case series and one literature review.

Results:

The three randomised, controlled trials (level of evidence 1b) showed no statistically significant differences in post-operative outcomes (in terms of complications) associated with head bandage use in middle-ear surgery. This finding was supported by the retrospective case series involving patients undergoing cochlear implantation.

Conclusion:

Current available evidence shows no advantage of head bandage use after middle-ear surgery. Head bandages may not be required after routine, uncomplicated middle-ear surgery.

Should the duration of head bandaging be reduced after pinnaplasty? A systematic review

BACKGROUND

It is common practice to use head bandages for 7-10 days following pinnaplasty. However, head bandages are often troublesome for patients and can lead to serious complications.

METHOD

A systematic review was performed to evaluate the use of head bandages after pinnaplasty. A search of Medline, Embase (Ovid) and CINAHL (EBSCO collections), the Cochrane Library, Pubmed (US National Library of Medicine) and Google Scholar identified 34 related articles. Of these, 14 were deemed relevant and 2 randomised controlled trials, 1 cohort study, 3 case series and 1 literature review met the inclusion criteria.

RESULTS

The two randomised controlled trials show no statistically significant difference in complications when a head bandage was used for the standard 7-10 days, for 24 hours or not at all. The three case series show that using a head bandage for 24 hours or not at all are safe alternatives. The review article recommended that when head bandages are applied after pinnaplasty it should be for the shortest duration possible.

CONCLUSION

Based on the available evidence, not using a head bandage at all or using one for a maximum of 24 hours following pinnaplasty is recommended.

Cerebrospinal fluid shunt operations without cranial bandaging. Clinical article

OBJECT

Cranial bandages are commonly applied over scalp incisions immediately after cerebrospinal fluid (CSF) shunt surgery, putatively to prevent complications, particularly infection. These bandages require resources, consume the time of healthcare workers, and incur non-negligible expenses. It is therefore both reasonable and important to examine the efficacy of cranial bandaging.

METHODS

The combined experience of 3 neurosurgeons over 6.75 years with using no cranial bandaging after operations for implantation or revision of CSF shunts is the basis of this report. These data were prospectively accrued and retrospectively analyzed.

RESULTS

The infection rate was 4.2% (95% CI 3.1-5.6%) for 1064 operations performed without postoperative cranial bandaging after either shunt insertion or revision surgery through clean or clean-contaminated wounds. The age distribution extended from premature infants through adults 77 years of age.

CONCLUSIONS

The results of this investigation support the position that bandaging scalp wounds after CSF shunt implantation or revision surgery adds no benefit beyond the easier, simpler, faster, and cheaper practice of using antibiotic ointment as a dressing without bandaging.

Bandages, dressings, and cranial neurosurgery

OBJECT

Bandages and dressings are commonly applied to incisional scalp wounds to prevent complications, particularly infection, during the early stages of wound healing. Bandaging cranial incisional wounds requires resources, consumes healthcare workers' time, and incurs expense; it is therefore important to examine its efficacy.

METHODS

All cranial operations (excluding shunt placements, procedures on the scalp alone, and bur hole procedures) performed between June 30, 2001 and January 1, 2006, by two neurosurgeons at either of two hospitals, one adult and one pediatric institution, were reviewed. Surgical site infections (SSIs) and other postoperative complications were investigated with respect to the use of bandaging for incisional wounds and other aspects of postoperative wound management. The operations were classified into four categories based on wound type: "clean," "clean-contaminated," "contaminated," and "dirty," according to the criteria of the Centers for Disease Control and Prevention.

CONCLUSIONS

A total of 702 operations were performed in 577 patients; only five patients received any type of surgical bandaging. There were four SSIs (0.57%; 95% confidence interval [CI] 0.16-1.45). The postoperative infection rate in the 626 clean cases was 0.48% (95% CI 0.10-1.39) and was 2.63% (95% CI 0.07-13.81) in the 38 clean-contaminated cases. The data obtained in this investigation is consistent with the position that bandaging incisional scalp wounds after cranial surgery adds little if any benefit beyond the easier, simpler, and cheaper practice of using antibiotic ointment as a dressing without bandaging.