title: Enhancing patient recovery following lower limb arthroplasty with a modern wound dressing: a prospective, comparative audit.
abstract: OBJECTIVE
  To assess current wound care practice, implement a potentially improved regimen and re-evaluate practice.
  
  
  METHODS
  Two prospective clinical audits were performed over a 6-month period, involving 100 patients undergoing hip or knee arthroplasty. Fifty consecutive patients with traditional dressings (Mepore; Mölnlycke) were evaluated prior to a change in practice to a modern dressing (Aquacel Surgical; ConvaTec). Fifty consecutive patients were then evaluated with the new dressing to complete the audit cycle. Clinical outcome measures were wear time, number of changes, blister rate and length of hospital stay. Statistical comparisons were performed using Mann Whitney or Fisher's exact test (statistical significance p < 0.05).
  
  
  RESULTS
  Wear time for the traditional dressing (2 days) was significantly shorter than for the modern dressing (7 days; p < 0.001), and required more changes (0 vs 3; p < 0.001). Twenty per cent of patients developed blisters with the traditional dressing compared with 4% with the modern dressing (p=0.028). Median length of stay was the same for the modern dressing (4 days) compared with the traditional dressing (4 days). In the modern dressing group, 75% of patients were discharged by day 4, whereas in the traditional group this took until day 6.
  
  
  CONCLUSIONS
  This audit highlights the problems associated with traditional dressings with frequent early dressing changes, blistering and delayed discharge. These adverse outcomes can be minimised with a modern dressing specifically designed for the demands of lower limb arthroplasty. Units planning to implement enhanced recovery regimens should consider adopting this dressing to avoid compromising patient discharge.
  
  
  BACKGROUND
  There were no external sources of funding for this audit; however, one author (JC) received reimbursement of expenses to attend and present work at educational conferences from ConvaTec.
authors.affiliation: Department of Trauma and Orthopaedics, Forth Valley Royal Hospital, Stirling, Scotland. hopperg@doctors.org.uk
authors.forename: G P
authors.initials: GP
authors.lastname: Hopper
authors.forename: A H
authors.initials: AH
authors.lastname: Deakin
authors.forename: E O
authors.initials: EO
authors.lastname: Crane
authors.forename: J V
authors.initials: JV
authors.lastname: Clarke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D047070:Bandages, Hydrocolloid; D001768:Blister / Q000517:prevention & control; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D006113:United Kingdom; D014945:Wound Healing