436 Early surgical dressing removal may be beneficial

July 13, 2014

PEARLS 436, July 2014, written by Brian R McAvoy

Clinical question
What are the benefits and risks of early removal (within 48 hours permanently) or delayed removal (beyond 48 hours permanently with interim dressing changes allowed) of a dressing covering a closed surgical incision site?

Bottom line
No significant differences were reported between the 2 groups in terms of wound infection, superficial wound dehiscence or the number of people experiencing serious adverse events. There were no deep wound infections or instances of complete wound dehiscence in the studies that reported these complications. Participants in the group that had early removal of dressings had significantly shorter hospital stays and incurred significantly lower treatment costs than those in the delayed removal of dressings group, but these results were based on very low quality evidence from 1 small randomised controlled trial.

Caveat
The point estimate supporting these findings was based on very low quality evidence from 3 small randomised controlled trials, and the confidence intervals around this estimate were wide. The studies were not large enough to identify small differences in complication rates. None of the studies reported quality of life.

Context
Following surgical closure, a dressing can act as a physical barrier to protect the wound until the continuity of the skin is restored (within about 48 hours). The dressing can also absorb exudate from the wound, keeping it dry and clean, and preventing bacterial contamination from the external environment. Some studies have found the moist environment created by some dressings accelerates wound healing, although others believe it is a disadvantage, as excessive exudate can cause maceration of the wound and surrounding healthy tissue.

Cochrane Systematic Review
Toon CD et al. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Reviews, 2013, Issue 9. Art. No.: CD010259.DOI: 10.1002/14651858. CD010259.pub2. This review contains 4 studies involving 280 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.