Practice Uncertainties

Do dressings prevent infection of closed primary wounds after surgery?

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2270 (Published 24 May 2016) Cite this as: BMJ 2016;353:i2270
  1. Jane Blazeby1 on behalf of the Bluebelle Study Group
  1. 1Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, and Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to: Jane Blazeby, j.m.blazeby{at}bristol.ac.uk

What you need to know

  • There is insufficient evidence to know whether dressings reduce the risk of surgical site infection in closed primary surgical wounds

  • Basic adhesive dressings may be used on closed primary surgical wounds as a pragmatic approach to provide a barrier to the wound and to absorb exudate

  • In specialties where it is common practice to not use dressings, continue with this practice until further evidence emerges

After surgery, the wound must try to heal. A dressing may be applied, with the expectation of improved healing, management of exudate, or reduced chance of surgical site infection. Surgical site infection is of particular importance to health services and patient outcomes. However, whether dressings are necessary and influence these issues is uncertain. Here we discuss uncertainty about wound dressings in closed primary surgical wounds.

A closed primary surgical wound is formed when the skin edges of the surgical wound are approximated. Wounds may be closed with sutures or clips. Epithelisation and connective tissue deposition seal the join. The wound may then be covered with a dressing. Many different types are available (box 1).1 Tissue adhesive “glue” may also be added as a dressing to a closed wound (fig 1).

Box 1: Summary of dressings types (from the British National Formulary1)

  • Basic wound contact dressing—Low adherence, usually cotton pads placed in contact with the wound, and may be absorbent

  • Advanced wound dressings*:

    • Hydrogel—Amorphous, cohesive topical application that can take up the shape of a wound

    • Vapour permeable†—Allow the passage of water vapour and oxygen but are impermeable to water and micro-organisms

    • Soft polymer—Include soft silicone polymer that may be adherent or non-adherent

    • Hydrocolloid—Occlusive hydrocolloid layer on a vapour permeable film

    • Foam—Contain hydrophilic polyurethane foam (adhesive or non-adhesive)

    • Alginate—Highly absorbent calcium alginate or sodium alginate, can be combined with collagen

    • Capillary action—Absorbent core of hydrophilic fibres sandwiched between low-adherent wound-contact layers

    • Odour absorbent—Contain …

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