Dressings and topical agents for surgical wounds healing by secondary intention.
BACKGROUND
Many different wound dressings and topical applications are used to cover surgical wounds healing by secondary intention. It is not known whether these dressings heal wounds at different rates.


OBJECTIVE
To assess the effectiveness of dressings and topical agents on surgical wounds healing by secondary intention


METHODS
We sought relevant trials from the Cochrane Central Register of Controlled Trials, Cochrane Wounds Group Specialised Trials Register, MEDLINE, EMBASE, and CINAHL databases in March 2002.


METHODS
All randomised controlled trials (RCTs) evaluating the effectiveness of dressings and topical agents for surgical wounds healing by secondary intention.


METHODS
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 eligible studies using a data extraction sheet, any disagreements were referred to a third reviewer.


RESULTS
Fourteen reports of 13 RCTs on dressings or topical agents for postoperative wounds healing by secondary intention were identified.
Whilst a single small trial of aloe vera supplementation vs gauze suggests delayed healing with aloe vera, the results of this trial are un interpretable since there was a large differential loss to follow up. A plaster cast applied to an amputation stump accelerated wound healing compared with elastic compression, WMD -25.60 days, 95% CI -49.08 to -2.12 days (1 trial). There were no statistically significant differences in healing for other dressing comparisons (e.g. gauze, foam, alginate; 11 trials). PAIN: Gauze was associated with significantly more pain for patients than other dressings (4 trials). PATIENT SATISFACTION: Patients treated with gauze were less satisfied compared with those receiving alternative dressings (3 trials).


RESULTS
Gauze is inexpensive but its use is associated with the use of significantly more nursing time than foam (2 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).


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
H
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ.
Ubbink
D
D
Goossens
A
A
de Vos
R
R
Legemate
D
D
D001458:Bandages; D006801:Humans; D009779:Occlusive Dressings; D016032:Randomized Controlled Trials as Topic; D013514:Surgical Procedures, Operative; D014945:Wound Healing