Surgical wounds healing by secondary intention: dressings and topical agents

ABSTRACTS OF RECENT COCHRANE WOUNDS GROUP REVIEWS

Surgical wounds healing by secondary intention: dressings and topical agents

This revie\,- should be cited as Vt>rmeu!t'n H, Ubbink D, Goossens 1\, de Vas R, Legemate D. Dressings ancl topical agent~ for surgical wounds healing by secondary intention. (Cochrane Review) In: The Cochrane Library, Issue 2,2004. Chichester, UK: John Wil y & Sons, Ltd.

here is insufficient evidence to suggest whether the

choice of dressing or topical agent affects the healing

of surgical wounds healing by secondary intention

although gnuze may be associated with greater pain or

discomfort fur the patient.

Most surgical incisions heal by primary intention, i.e. the

edges of the surgical incision are closed torrether with

stitches or clips llnti! the cut edges merge. HeaUng by

secondary intention refers to healing of an open wound,

from the base upwards, hy laying down new tissue. There

are many kinds of dressings and topical agents available but

few have been evaluated in trials. This review did not find

any eVidence that anyone dressing or topical agent speeds up the healing of surgical wounds healing by secondary

intention more than another.

Background

Many different wound dressings and topical applications

are llsed to cover surgical wounds healing by secondary

intention. It is not known whether these dressings heal wounds at different rates.

Objectives

To assess the effectiveness of dressings and topical agents

on surgical wounds healing by secondary intention.

Search strategy

We sought relevant trials from the Cochrane Central

Register of Controlled Trials, Cochrane Wounds Group

Specialised Trials Register, p,IIEDLINE, EMBASE, and

CINAHL databases in March 2002.

Selection criteria

All randomised controlled trials (RCTs) evaluating the

effectiveness of dressings and topical agents for surgical

wounds healing by secondary intention.

Data collection and analysis

Eligibility for inclusion was confirmed by two reviewers who

independently judged the methodological quality of the

trials according to the Dutch Cochrane Centre list of factors

relating to internal and external validity. Two reviewers

summarised data from eligihle studies using a data extraction

sheet, any disagreements were referred to a third reviewer.

Main results

Fourteen reports of 13 RCTs on dressings or topical agents

for postoperative wounds healing by secondary intention

were identified.

\"'ound healing: \Nhilc a single small trial of aloe vera supplementation vs gauze suggests delayed healing with

aloe vera, the results of this trial are uninterpretable since

there was a large differential loss to follow up. A plaster

cast applied to an amputation stump accelerated wound

healing compared wit.h elastiC compression, weighted

mean difference (WiVlD) = -25.60 days, 95% confidence

interval (Cf) = -49.08 to -2. I 2 days (one trial). There were

no statistically significant differences in healing for other

dressing comparisons (e.g. gauze, foam, alginate; I I trials).

Pain: Gauze was associated with significantly more pain for

patients than other dressings (four trials).

Patient satisfaction: Patients treated with gauze were less

satisfied compared with those receiving alternative

dressings (three trials).

Costs: Gauze is inexpensive but its use is associated with the

use of significantly more nursing time than foam (two trials).

Length of hospital stay: Four trials showed no difference in

length of hospital stay. One trial found shorter hospital stay

in people after amputation when plaster casts were applied

compared with elastic compression (WMD = -30.10 days;

95% CI = -49.82 to -'10.38).

Reviewers' conclusions

We found only small, poor quality trials; the evidence is therefore insufficient to determine whether the choice of

dressing or topical agent affects the healing of surgical wounds healing by secondary intention. Foam is best studied

as an alternative for gauze and appears to be preferable as to pain reduction, patient satisfaction and nursing time.

Vermeulen H, Ubbink D, Goossens A, de Vas R, LegemClte D

JOURNAL OF TISSUE VIABILITY VOL 14 NO.2 APRIL 2004 68