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. 2004;2004(2):CD003554.
doi: 10.1002/14651858.CD003554.pub2.

Dressings and topical agents for surgical wounds healing by secondary intention

H Vermeulen  1 , D Ubbink, A Goossens, R de Vos, D Legemate
Affiliations

Dressings and topical agents for surgical wounds healing by secondary intention

H Vermeulen et al. Cochrane Database Syst Rev. 2004.

Abstract

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.

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, MEDLINE, 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 eligible 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.

Wound healing: 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).

Costs: 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).

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.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 FOAM VERSUS GAUZE, Outcome 1 Time to healing pooled.
1.2
1.2. Analysis
Comparison 1 FOAM VERSUS GAUZE, Outcome 2 District nursing visits.
1.3
1.3. Analysis
Comparison 1 FOAM VERSUS GAUZE, Outcome 3 Hospital stay.
3.1
3.1. Analysis
Comparison 3 ALGINATE VERSUS GAUZE, Outcome 1 Wound size reduction (cm2) per day.
3.2
3.2. Analysis
Comparison 3 ALGINATE VERSUS GAUZE, Outcome 2 Wound size reduction (cm3) per day.
3.3
3.3. Analysis
Comparison 3 ALGINATE VERSUS GAUZE, Outcome 3 Satisfaction with dressing. First week: during dressing changes (VAS 10‐point scale).
3.4
3.4. Analysis
Comparison 3 ALGINATE VERSUS GAUZE, Outcome 4 Satisfaction with dressing. First week: between dressing changes (VAS 10‐point scale).
3.5
3.5. Analysis
Comparison 3 ALGINATE VERSUS GAUZE, Outcome 5 Satisfaction with dressing. Last visit: during dressing changes (VAS 10‐point scale).
3.6
3.6. Analysis
Comparison 3 ALGINATE VERSUS GAUZE, Outcome 6 Satisfaction with dressing. Last visit: between dressing changes (VAS 10‐point scale).
5.1
5.1. Analysis
Comparison 5 GAUZE WITH ALOE VERA VERSUS GAUZE, Outcome 1 Time to healing.
6.1
6.1. Analysis
Comparison 6 FOAM VERSUS BEAD, Outcome 1 Time to healing.
6.2
6.2. Analysis
Comparison 6 FOAM VERSUS BEAD, Outcome 2 Time to painfree in days.
8.1
8.1. Analysis
Comparison 8 PLASTER CAST VERSUS ELASTIC COMPRESSION, Outcome 1 Time to healing.
8.2
8.2. Analysis
Comparison 8 PLASTER CAST VERSUS ELASTIC COMPRESSION, Outcome 2 Hospitalisation.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD003554

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