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Meta-Analysis
. 2016 Mar 29;3(3):CD011712.
doi: 10.1002/14651858.CD011712.pub2.

Antibiotics and antiseptics for surgical wounds healing by secondary intention

Gill Norman  1 , Jo C Dumville, Devi Prasad Mohapatra, Gemma L Owens, Emma J Crosbie
Affiliations
Meta-Analysis

Antibiotics and antiseptics for surgical wounds healing by secondary intention

Gill Norman et al. Cochrane Database Syst Rev. .

Abstract

Background: Following surgery, incisions are usually closed by fixing the edges together with sutures (stitches), staples, adhesives (glue) or clips. This process helps the cut edges heal together and is called 'healing by primary intention'. However, a minority of surgical wounds are not closed in this way. Where the risk of infection is high or there has been significant loss of tissue, wounds may be left open to heal by the growth of new tissue rather than by primary closure; this is known as 'healing by secondary intention'. There is a risk of infection in open wounds, which may impact on wound healing, and antiseptic or antibiotic treatments may be used with the aim of preventing or treating such infections. This review is one of a suite of Cochrane reviews investigating the evidence on antiseptics and antibiotics in different types of wounds. It aims to present current evidence related to the use of antiseptics and antibiotics for surgical wounds healing by secondary intention (SWHSI).

Objectives: To assess the effects of systemic and topical antibiotics, and topical antiseptics for the treatment of surgical wounds healing by secondary intention.

Search methods: In November 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched three clinical trials registries and the references of included studies and relevant systematic reviews. There were no restrictions with respect to language, date of publication or study setting.

Selection criteria: Randomised controlled trials which enrolled adults with a surgical wound healing by secondary intention and assessed treatment with an antiseptic or antibiotic treatment. Studies enrolling people with skin graft donor sites were not included, neither were studies of wounds with a non-surgical origin which had subsequently undergone sharp or surgical debridement or other surgical treatments or wounds within the oral or aural cavities.

Data collection and analysis: Two review authors independently performed study selection, risk of bias assessment and data extraction.

Main results: Eleven studies with a total of 886 participants were included in the review. These evaluated a range of comparisons in a range of surgical wounds healing by secondary intention. In general studies were small and some did not present data or analyses that could be easily interpreted or related to clinical outcomes. These factors reduced the quality of the evidence.Two comparisons compared different iodine preparations with no antiseptic treatment and found no clear evidence of effects for these treatments. The outcome data available were limited and what evidence there was low quality.One study compared a zinc oxide mesh dressing with a plain mesh dressing. There was no clear evidence of a difference in time to wound healing between groups. There was some evidence of a difference in measures used to assess wound infection (wound with foul smell and number of participants prescribed antibiotics) which favoured the zinc oxide group. This was low quality evidence.One study reported that sucralfate cream increased the likelihood of healing open wounds following haemorrhoidectomy compared to a petrolatum cream (RR: 1.50, 95% CI 1.13 to 1.99) over a three week period. This evidence was graded as being of moderate quality. The study also reported lower wound pain scores in the sucralfate group.There was a reduction in time to healing of open wounds following haemorrhoidectomy when treated with Triclosan post-operatively compared with a standard sodium hypochlorite solution (mean difference -1.70 days, 95% CI -3.41 to 0.01). This was classed as low quality evidence.There was moderate quality evidence that more open wounds resulting from excision of pyomyositis abscesses healed when treated with a honey-soaked gauze compared with a EUSOL-soaked gauze over three weeks' follow-up (RR: 1.58, 95% CI 1.03 to 2.42). There was also some evidence of a reduction in the mean length of hospital stay in the honey group. Evidence was taken from one small study that only had 43 participants.There was moderate quality evidence that more Dermacym®-treated post-operative foot wounds in people with diabetes healed compared to those treated with iodine (RR 0.61, 95% CI 0.40 to 0.93). Again estimates came from one small study with 40 participants.

Authors' conclusions: There is no robust evidence on the relative effectiveness of any antiseptic/antibiotic/anti-bacterial preparation evaluated to date for use on SWHSI. Where some evidence for possible treatment effects was reported, it stemmed from single studies with small participant numbers and was classed as moderate or low quality evidence. This means it is likely or very likely that further research will have an important impact on our confidence in the estimate of effect, and may change this estimate.

PubMed Disclaimer

Conflict of interest statement

Gill Norman: my employment at the University of Manchester is funded by NIHR and focuses on high priority Cochrane reviews in the prevention and treatment of wounds.

Jo Dumville: nothing to declare.

Devi Prasad Mohapatra: nothing to declare.

Gemma Owens: is a recipient of an MCRC Clinical Research Training Fellowship and previously received a Wellbeing of Women Entry Level Scholarship.

Emma Crosbie: is a Scientific Editor for BJOG, has received funding from an NIHR Clinician Scientist Award, the HTA, Wellbeing of Women/the Wellcome Trust and Central Manchester University Hospitals NHS Foundation Trust. She is an employee of the University of Manchester.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Polyvidone iodine‐impregnated mesh compared with alginate mesh, Outcome 1: Proportion of wounds healed
1.2
1.2. Analysis
Comparison 1: Polyvidone iodine‐impregnated mesh compared with alginate mesh, Outcome 2: Wound infection
1.3
1.3. Analysis
Comparison 1: Polyvidone iodine‐impregnated mesh compared with alginate mesh, Outcome 3: Mean number of dressing changes
2.1
2.1. Analysis
Comparison 2: Zinc oxide mesh compared with placebo, Outcome 1: Wound infection (based on presence of smell)
2.2
2.2. Analysis
Comparison 2: Zinc oxide mesh compared with placebo, Outcome 2: Participants prescribed antibiotics
3.1
3.1. Analysis
Comparison 3: Sucralfate compared with petrolatum, Outcome 1: Proportion of wounds healed
3.2
3.2. Analysis
Comparison 3: Sucralfate compared with petrolatum, Outcome 2: Pain score (10‐point VAS scale)
4.1
4.1. Analysis
Comparison 4: Trimethoprim‐sulfamethoxazole compared with placebo, Outcome 1: Adverse events (attributed to medication)
4.2
4.2. Analysis
Comparison 4: Trimethoprim‐sulfamethoxazole compared with placebo, Outcome 2: Wound recurrence
5.1
5.1. Analysis
Comparison 5: Honey compared with EUSOL, Outcome 1: Proportion of wounds healed
5.2
5.2. Analysis
Comparison 5: Honey compared with EUSOL, Outcome 2: Mean length of hospital stay
6.1
6.1. Analysis
Comparison 6: Iodine compared with Dermacyn®, Outcome 1: Proportion of wounds healed
7.1
7.1. Analysis
Comparison 7: Triclosan compared with sodium hypochlorite, Outcome 1: Time to wound healing
7.2
7.2. Analysis
Comparison 7: Triclosan compared with sodium hypochlorite, Outcome 2: Adverse events (bleeding/secretions)
7.3
7.3. Analysis
Comparison 7: Triclosan compared with sodium hypochlorite, Outcome 3: Pain
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011712

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