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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