Dressings and topical agents to help surgical wounds heal by secondary intention

Most surgical incisions heal by primary intention, i.e. the edges of the surgical incision are closed together with stitches or clips until the cut edges merge. Healing by secondary intention refers to healing of an open wound, from the base upwards, by laying down new tissue. There are many kinds of dressings and topical agents available but few have been evaluated in trials. This review did not find any evidence that any one dressing or topical agent speeds up the healing of surgical wounds healing by secondary intention more than another, although gauze may be associated with greater pain or discomfort for the patient.

Authors' 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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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).

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