Clinical benefit of a hydrocolloid dressing in closed surgical wounds

Considerations for an ideal post-surgical wound dressing aligned with antimicrobial stewardship objectives: a scoping review

OBJECTIVE

Most surgical wounds heal by primary or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection (SSI), either of which can increase risk of morbidity and mortality. The use of antimicrobials to treat infection in these wounds is prevalent, but there is now an imperative to align treatment with reducing antimicrobial resistance and antimicrobial stewardship (AMS). The aim of this review was to explore the published evidence identifying general considerations/criteria for an ideal post-surgical wound dressing in terms of overcoming potential wound healing challenges (including infection) while supporting AMS objectives.

METHOD

A scoping review examining evidence published from 1954-2021, conducted by two authors acting independently. Results were synthesised narratively and have been reported in line with PRISMA Extension for Scoping Reviews.

RESULTS

A total of 819 articles were initially identified and subsequently filtered to 178 for inclusion in the assessment. The search highlighted six key outcomes of interest associated with post-surgical wound dressings: wound infection; wound healing; physical attributes related to comfort, conformability and flexibility; fluid handling (e.g., blood and exudate); pain; and skin damage.

CONCLUSION

There are several challenges that can be overcome when treating a post-surgical wound with a dressing, not least the prevention and treatment of SSIs. However, it is imperative that the use of antimicrobial wound dressings is aligned with AMS programmes and alternatives to active antimicrobials investigated.

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

OBJECTIVE

  To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients.

BACKGROUND

  Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications.

RECOMMENDATIONS

  These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma.

Surgical wound management made easier and more cost-effective

Evidence-based guidelines for the prevention of surgical site infection (SSI) have been published by the U.S. Centers for Disease Control and Prevention (CDC). According to these guidelines, a wound should usually be covered with a sterile dressing for 24 to 48 h when a surgical incision is closed primarily. However, it is not recommended that an incision be covered by a dressing beyond 48 h. In this study, patients were stratified into two groups for analysis: patients whose surgical wound was sterilized and whose gauze was changed once daily until postoperative day 7 (7POD; group A); and patients whose surgical wound was sterilized and whose gauze was changed once daily until 2POD (group B). We evaluated the incidence of SSI, nursing hours and cost implications. The results showed that there was no significant difference in SSI occurrence between the two groups (group A, 10% vs. group B, 7.3%). By contrast, the average nursing time differed by 2.8 min (group A, 3.8 min vs. group B, 0.9 min). The material costs per patient were also reduced by $14.70 (group A, $61.80 vs. group B, $47.10). In conclusion, we applied our knowledge of the evidence-based CDC guidelines to determine whether 48-h wound management can be made easier, more uniform and more cost-effective compared to conventional wound management. The results of the present study showed that surgical wound management methods can be more convenient and inexpensive.

A new hydrocolloid dressing prevents surgical site infection of median sternotomy wounds

PURPOSE

This prospective and semi-randomized study was conducted to clarify the effectiveness of a new hydrocolloid dressing placed over median sternotomy wounds using an occlusive dressing technique.

METHODS

The subjects were 253 patients undergoing coronary artery bypass grafting (CABG), who were randomized to receive either the new hydrocolloid dressing (Karayahesive, n = 117) or a polyurethane foam dressing (Tegaderm plus Pad, n = 136) immediately after sternal wound closure. Karayahesive was left in place for 7 days, whereas the Tegaderm plus Pad was removed on postoperative day (POD) 2 and replaced with an adhesive wound dressing until POD 7.

RESULTS

In the Karayahesive group, complete integrity of the wound was achieved in 91% of the patients, with an infection developing in 3.4%: as a superficial surgical site infection (SSI) in three and as a deep SSI in one. On the other hand, in the Tegaderm plus Pad group, an infection developed in 10.3% (14 patients) of the patients: as a superficial SSI in nine and as a deep SSI in five (P < 0.05). The total treatment costs from the application of the dressing until completion of treatment was 699 yen for the Karayahesive and 910 yen for the Tegaderm plus Pad (P < 0.001).

CONCLUSIONS

The new hydrocolloid dressing, applied with an occlusive dressing technique to median sternotomy wounds, prevented SSI and was cost effective.

Hydrocolloid dressings in the management of acute wounds: a review of the literature

A review of the literature suggests that the application of self-adhesive hydrocolloid dressings, most commonly associated with the treatment of ulcerative conditions such as pressure ulcers and leg ulcers, may also offer benefits in the management of acute wounds of all types, for example decreasing healing times of donor sites by about 40% compared with traditional treatments. Healing times of superficial traumatic injuries and surgical wounds are similarly enhanced but in the treatment of burns, the principal benefit appears to be a reduction in wound pain, an effect that has also been reported in virtually all other wound types. The impermeable nature of hydrocolloids provides a protective covering to the wound, permitting washing or showering while helping to prevent the spread of pathogenic microorganisms. There also appear to be significant cost-benefits associated with the use of hydrocolloids. In recent years, hydrocolloid dressings have been replaced by other products such as foams for the treatment of more heavily exuding wounds but for more lightly exuding wounds they still offer many practical advantages and as such will undoubtedly continue to meet an important need in wound management practice.

The use of gauze: will it ever change?

Although the benefits of healing in a moist environment have been published worldwide, the use of woven gauze as a wound contact material still prevails in many countries. This article traces the history of gauze and problems associated with usage against the introduction of one of the first modern materials, the hydrocolloid. Why this revolution in dressing material did not herald an immediate change of practice away from gauze is examined. Since the 1970s, the range, availability and sophistication of these and other moisture-retentive dressings have increased dramatically, and yet it seems that some practitioners remain unconvinced. The processes that underpin personal and organisational change that may contribute to this reluctance are also considered.

A prospective, randomised, controlled trial comparing wound dressings used in hip and knee surgery: Aquacel and Tegaderm versus Cutiplast

INTRODUCTION

Cutiplast (absorbent perforated dressing with adhesive border; Smith & Nephew) is commonly used following orthopaedic operation, but complications of its use have been reported. A prospective, randomised, controlled study was performed to compare the efficacy of Cutiplast versus an Aquacel (hydrofibre dressing; ConvaTec) covered with Tegaderm (vapour-permeable dressing; 3M).

PATIENTS AND METHODS

Two-hundred patients were randomised to receive one of the two dressings following elective and non-elective surgery of the hip and the knee. We were able to study 183 patients. The condition of the wound and any complications such as skin blistering or signs of infection was noted as was the frequency of dressing changes.

RESULTS

The Aquacel and Tegaderm dressing was 5.8 times more likely to result in a wound with no complications as compared to a Cutiplast dressing (odds ratio, 5.8; 95% CI 2.8-12.5; P < 0.00001).

CONCLUSION

Aquacel covered by Tegaderm is a superior dressing to Cutiplast following surgery to the hip and knee.