Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds

Toon, Clare D; Lusuku, Charnelle; Ramamoorthy, Rajarajan; Davidson, Brian R; Gurusamy, Kurinchi Selvan

doi:10.1002/14651858.cd010259.pub3

Cited by 46 publications

(44 citation statements)

References 34 publications

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“…Several studies addressing early versus delayed showering of patients with a surgical wound found no difference in the development of infections [127,128]. Furthermore, studies of early versus delayed dressing removal after primary closure summarised in a Cochrane database showed no apparently significant difference between early (up to 48 hours after surgery) and delayed (beyond 48 hours) removal [122]. Those findings were based on three small randomised controlled trials, so some uncertainty remains regarding the exact timing of dressing removal.…”

Section: Post-operative Prevention Measuresmentioning

confidence: 99%

“…Because the daily absorption of triclosan from these sutures is rather low, the chance of developing resistance remains low. Sutures impregnated with other antimicrobial agents are being tested [15], and wound dressings are used to provide physical support and protection from bacterial contamination and absorb exudate [121,122]. A Cochrane review analysed several studies that assessed the effect of wound dressings in preventing SSIs.…”

Section: Surgical Debridement and Irrigationmentioning

confidence: 99%

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Prevention of fracture-related infection: a multidisciplinary care package

Metsemakers

Onsea

Neutjens

et al. 2017

International Orthopaedics (SICOT)

100

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Fracture-related infection (FRI) remains a challenging complication. It may result in permanent functional loss or even amputation in otherwise healthy patients. For these reasons, it is important to focus attention on prevention. In treatment algorithms for FRI, antibiotic stewardship programmes have already proved their use by means of a multidisciplinary collaboration between microbiologists, surgeons, pharmacists, infectious disease physicians and nursing staff. A similar approach, however, has not been described for infection prevention. As a first step towards achieving a multidisciplinary care package for infection prevention, this review summarises the most recent guidelines published by the World Health Organization (WHO) and US National Institutes of Health Centers for Disease Control and Prevention (CDC), primarily focusing on the musculoskeletal trauma patient. The implementation of these guidelines, together with close collaboration between infection control physicians, surgeons, anaesthesiologists and nursing staff, can potentially have a beneficial effect on the rate of FRI after musculoskeletal trauma surgery. It must be stated that most evidence presented here in support of these guidelines was not obtained from musculoskeletal trauma research. Although most preventive measures described in these studies can be generalised to the musculoskeletal trauma patient, there are still important differences with nontrauma patients that require further attention. Future research should therefore focus more on this very defined patient population and more specifically on FRI prevention.

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Section: Post-operative Prevention Measuresmentioning

confidence: 99%

Section: Surgical Debridement and Irrigationmentioning

confidence: 99%

Prevention of fracture-related infection: a multidisciplinary care package

Metsemakers

Onsea

Neutjens

et al. 2017

International Orthopaedics (SICOT)

100

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“…16 Dressings are thought to be a barrier that protects wounds from microorganisms in the outside environment. 72 Bathing and showering is also a controversial matter. 71 No evidence showed that a particular type of dressing was better than any other at preventing SSIs.…”

Section: Postoperative Phasementioning

confidence: 99%

Surgical Site Infections in Dermatologic Surgery

Saleh

Schmidtchen

2015

Dermatologic Surgery

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“…In 2015, a Cochrane review concluded that early removal of dressings from surgical wounds appears to have no negative effect on the outcomes. However, this recommendation is based on very low quality evidence from three small trials . Dumville et al.…”

Section: Introductionmentioning

confidence: 99%

“…However, this recommendation is based on very low quality evidence from three small trials. 14 Dumville et al con-cluded that there is not enough evidence to ascertain whether covering surgical wounds reduces the risk of infection. However, there is no absolute guidance regarding the timing of dressing removal.…”

mentioning

confidence: 99%

Timing of staples and dressing removal after cesarean delivery (the SCARR study)

Heinemann

Solnica

Abdelkader

et al. 2019

Intl J Gynecology & Obste

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Objective To investigate optimal timing of dressing and staples removal after cesarean delivery (CD). Methods This prospective clustered clinical trial enrolled women undergoing CD between January 1, 2013, and October 31, 2014, at Hadassah–Hebrew University Hospital, Jerusalem. Women were assigned to one of five clusters differing in timing of dressing and staples removal. We assessed scar healing at 6 weeks. Results 920 women completed telephone questionnaires. Wound healing did not differ significantly among the clusters: the healing complication rate was 21% in the control group (n=46) and ranged from 18% to 26% (n=27–50) in clusters two to five (P=0.49). More healing complications were observed in women with a body mass index (BMI) of more than 35 kg/m2 versus 35 kg/m2 or less (P=0.016), urgent versus elective CD (P=0.013), preterm premature rupture of the membranes (PPROM) versus intact membranes (P=0.016), and chorioamnionitis at delivery versus no chorioamnionitis (P=0.001). 586 (64%) women underwent physician assessment at staples removal and at 6 weeks post CD. Conclusions Timing of dressing and staples removal has no effect on CD scar healing in low‐ and high‐risk parturients. A BMI of more than 35 kg/m2, urgent CD, PPROM, and chorioamnionitis were associated with mal‐healing, regardless of cluster. Clinicaltrials.gov: NCT01724255.

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Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds

Abstract: Early versus delayed dressing removal a er primary closure of clean and clean-contaminated surgical wounds.

Cited by 46 publications

References 34 publications

Prevention of fracture-related infection: a multidisciplinary care package

Prevention of fracture-related infection: a multidisciplinary care package

Surgical Site Infections in Dermatologic Surgery

Timing of staples and dressing removal after cesarean delivery (the SCARR study)

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