rss
Evid Based Nurs 12:52 doi:10.1136/ebn.12.2.52
  • Treatment

Occlusive dressings and gauze dressings did not differ for healing open wounds in surgical patients

D T Ubbink

Dr D T Ubbink, Academic Medical Center, Amsterdam, The Netherlands; d.ubbink{at}amc.nl

QUESTION

How do occlusive dressings compare with gauze dressings for healing open wounds in surgical patients?

METHODS

Design:

randomised controlled trial. Current Controlled Trials ISRCTN56264738.

Allocation:

concealed.

Blinding:

blinded {data collectors and outcome assessors}.*

Follow-up period:

up to complete wound healing or 6 months.

Setting:

Academic Medical Center, Amsterdam, The Netherlands.

Patients:

285 surgical inpatients (mean age 57 y, 65% men) with open wounds requiring local wound care. Exclusion criteria included burn wounds, ulcerating malignancies, closed wounds, ostomies or drain openings, pin holes from external fracture fixation materials, and chemotherapy or local irradiation.

Intervention:

local wound care with occlusive (n = 142) or gauze dressings (n = 143).

Outcomes:

included complete wound healing, time to wound healing, pain during dressing changes (10-cm visual analogue scale [VAS]; 0  =  no pain, 10  =  worst pain), length of hospital stay, and costs. The study had 90% power to detect a clinically relevant difference of 10% in wound healing with a standard deviation of 12.5 days.

Patient follow-up:

97% (intention-to-treat analysis).

MAIN RESULTS

Groups did not differ for complete wound healing, time to wound healing, or pain (table). The occlusive dressing group had a longer hospital stay and incurred higher total costs than the gauze dressing group (table).

CONCLUSION

Occlusive dressings and gauze dressings did not differ for healing open wounds or pain in surgical patients; gauze dressings incurred lower costs than occlusive dressings.

*Information provided by author.

ABSTRACTED FROM

Ubbink DT, Vermeulen H, Goossens A, et al. Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial. Arch Surg 2008;143:950–5.

Occlusive v gauze dressings for open wounds in surgical patients*

Clinical impact ratings: Perioperative 5/7; General surgery 6/7; Wound care 6/7

Footnotes

  • Source of funding: Smith & Nephew; Johnson & Johnson; ConvaTec; 3M.

Commentary

Gauze has been associated with increased pain and discomfort in healing surgical wounds by secondary intention.1 However, supporting evidence is weak.1 Moist wound healing has been considered the “gold standard” for most wounds.2 The study by Ubbink et al evaluated an important area of practice for clinicians: occlusion v non-occlusion. The large, well-designed study has many strengths. It was done in a routine clinical setting that is recognisable to many practitioners. The sample size was sufficiently large to detect clinically important differences in healing times, and allocation was concealed. The 6-month follow-up was appropriate to assess healing outcomes and adverse events. This was further strengthened by intention-to-treat analysis and blinded outcome evaluation. Use of the “red, yellow, and black” tool was a reasonable method of wound assessment in a clinical setting that included inpatient, outpatient, and home care. An important consideration is that all nurses were trained in correct use of comparator dressings, thus optimising dressing usage in the comparison group. Most wounds (almost 80%) were postoperative or trauma wounds; although the results were not stratified according to aetiology, Ubbink et al suggested that findings should only be applied to postoperative and trauma wounds. Clinicians may be particularly interested that patients with non-occluded wounds had 5 less hospital days and healed in a median 21 days less than those with occluded wounds (although the latter difference was not statistically significant). When combined with low pain scores and significantly lower total hospital costs in patients with non-occluded wounds, these findings suggest that gauze dressings can be used on many traumatic and surgical wounds without any reduction in important outcomes.

References

Free Sample

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EBN.
View free sample issue >>

EBN Journal Chat

The EBN Journal Chat offers readers the opportunity to participate in discussion about research articles and commentaries from Evidence Based Nursing (EBN).

How to participate >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.