Postoperative Dressings Research Articles

The therapeutic effect of dressing of exposed reconstructed auricle on patients after reconstruction of auricle

The dressing of the reconstructed auricle after total auricle reconstruction surgery is an important measure of postoperative nursing. However, a uniform dressing of the reconstructed auricle after total auricle reconstruction surgery has not been formed. We carried out this clinical study to provide a new idea and method for the postoperative dressing of reconstructed auricle by comparing the therapeutic effect of the completely covered dressing method and the dressing method of exposed reconstructed auricle. Clinical data and postoperative data of patients with microtia treated by total auricle reconstruction in Plastic Surgery Hospital from January 2023 to January 2024 were retrospectively collected. Patients treated with the completely covered dressing method after surgery were included in the control group, and patients treated with the dressing method of exposed reconstructed auricles after surgery were included in the experimental group. A total of 45 patients were in the experimental group and 48 patients in the control group. In terms of postoperative complications, the incidence of complications was 8.89% in the experimental group and 37.5% in the control group (P< 0.05). In terms of the satisfaction rate of patients and their families, the satisfaction rate of the experimental group was 97.78%, and that of the control group was 83.3% (P< 0.05). Compared with the traditional method of the completely covered dressing method after total auricle reconstruction surgery, the dressing method of exposed reconstructed auricle has a lower complication rate, a higher satisfaction rate of patients and their families, and a better therapeutic effect for patients after total auricle reconstruction surgery.

A single-centre RetrospeCtive sTudy Investigating patient-reported outcomeS of extended dressing wear time for incisional healing following orthopaedic surgery: the ARCTIS study.

Orthopaedic surgery is an effective intervention for treating the symptoms of degenerative joint disease or osteoarthritis (OA). Frequent wound dressing changes, unless clinically indicated, can disrupt the healing process and increase the occurrence of incision site contamination. Protection from contamination is critical for surgical incisions and, therefore, undisturbed wound healing (UWH) in surgical wound management is vital. This article describes a retrospective study reporting the clinical performance of a self-adherent, absorbent postoperative dressing, with a focus on dressing wear time. A single-centre, retrospective electronic medical record review of a convenience sample of adult patients treated with a dressing (Mepilex Border Post Op; Mölnlycke, Sweden) following elective hip or knee replacement was undertaken. Data relating to dressing wear time, rationale for dressing changes and patient-reported outcomes were extracted from a mobile health application moveUP Therapy (moveUP NV, Belgium). Health-related quality of life assessment was conducted using the EQ-5D-5L questionnaire and orthopaedic-specific quality of life (QoL) indicator tools. Of the 558 records reviewed, 151 respondents (27.1%) reported outcomes relating to dressing wear time and frequency of dressing change. The average wear time of the first dressing was 13.6 days (second dressing: 5.3 days). The proportion of patients who wore the first dressing for 1-7 days, 8-13 days and for ≥14 days was 17.2%, 13.2% and 69.5%, respectively. Data from the completed questionnaires revealed improvement in QoL over time. The results of this study are a good indicator of the suitability of the postoperative dressing for a 14-day wear time, in line with the principles of UWH.

Incisional negative pressure wound therapy (PrevenaTM) vs. conventional post-operative dressing after immediate breast reconstruction: a randomized controlled clinical trial

BackgroundSurgical complications following breast reconstruction remain a significant concern. This study aimed to investigate if incisional negative pressure wound therapy (iNPWT) using Prevena™ provides superior wound treatment for patients undergoing immediate breast reconstruction (IBR) compared to conventional postoperative dressing. Additionally, we investigated whether intraoperative indocyanine green angiography (ICG-A) could predict and prevent postoperative complications.MethodsA randomized controlled study (RCT) comprising 39 patients was conducted. The primary outcome was time until surgical drain removal. ICG-A was applied to evaluate tissue perfusion and compared to rate of postoperative complications. Patients were followed for one year, including postoperative complications, quality of life (QoL), scar evaluation, incidence of lymphedema and timely administration of adjuvant therapy.ResultsNo significant differences were observed in time to surgical drain removal, hospitalization or incidence of postoperative complications between the two groups. Analysis revealed no significant association between ICG-A results and postoperative complications. After one year, both groups exhibited similar QoL and satisfaction with scars. One patient developed lymphedema during follow-up, and adjuvant treatment was timely administered in 82%.ConclusionsThis RCT investigated iNPWT by Prevena™ compared to conventional postoperative dressing in IBR using implants or tissue expanders. ICG-A was applied to assess tissue perfusion and compared to postoperative complications. We did not find any significant differences in recovery time, hospitalization duration, postoperative complication rates, QoL, or scar satisfaction between the two groups within a one-year follow-up. Additionally, there were no significant association between ICG-A and postoperative complications. Larger randomized studies incorporating intraoperative ICG-A are needed to obtain higher quality data.Level of Evidence: Level I, Risk/Prognostic

Early postoperative water exposure does not increase complications in cutaneous surgeries: A randomized, investigator-blinded, controlled trial

Patients are often advised to keep the initial postoperative dressings dry and undisturbed for 24 to 72 hours. However, these requirements may result in significant disruption of patients' activities of daily living, such as bathing, leisure, and exercise. Compare standard management of keeping wounds dry and covered (48 hours) with early (6 hours) postoperative water exposure. Investigator-blinded, randomized (1:1), controlled trial evaluating rate of infection and additional outcomes of interest. Overall, 437 patients were randomized to either the early (6-hour) water exposure (n=218) intervention group or the standard cohort (n=219). The incidence of culture-proven infection in the intervention group (1.8%) was similar to the standard group (1.4%) (P>.99). There was also no difference in rates of bleeding or bruising. Scar assessment using the Patient and Observer Scar Assessment Scale revealed similar scar outcomes. Single site, academic center. Surgical wounds can be allowed to get wet in the immediate postoperative period with no increased incidence of infection or other complications and with similar cosmesis.

Utility of Applying Pressure Dressing Following Parotidectomy Compared to Conventional Dressing: A Benefit or Not?

BackgroundPost-parotidectomy wound dressing techniques lack of robust evidence, creating variation in practice. The choice between conventional and pressure dressing is typically based on expert opinions and individual preferences and the anticipated benefits of reduced drainage and shorter drain retention in pressure dressing hasn’t demonstrate yet. PurposeThe purpose of this study is to assess the advantage of pressure dressing following parotidectomy compared to conventional dressing. Study design, setting, sampleThis study was a open-label randomized controlled trial recruiting the patients aged 18 and above undergoing parotidectomy at the Otolaryngology Department of King Chulalongkorn Memorial Hospital between March 2021 and September 2022. Our exclusion criteria were as following: (1) underwent parotidectomy combined with neck dissection, (2) prior irradiation to the parotid gland or head and neck region, (3) prior parotidectomy within the previous year, (4) consumption of anticholinergic medications, (5) bleeding disorders or coagulopathies. Predictor/exposure/independent variableThe predictor variable was postoperative dressing and subjects were randomly assigned to pressure or conventional dressing Main outcome variable(s)The primary outcome variables were drain output (ml) measured every 8 hours and reported in the term of total drain output and duration of drain use. The secondary outcome variables were post-parotidectomy complications (if any), complications from the pressure dressing and pain scores. CovariatesThe covariates were underlying disease, smoking, alcohol drinking, types of parotidectomy (extension of surgery) and pathologic result. AnalysesThe appropriate uni- and bivariate statistics were computed, and the level of statistical significance was set at P-value < 0.05. ResultsA total of 40 patients were enrolled, with 20 in each group. Average age was 59.10±10.60 years in pressure dressing group and 55.70±18.90 years in conventional dressing group. Baseline characteristics were the same in both groups. The average volume of drain output in the pressure dressing group was 44.25 ± 25.20 ml, compared to 37.05 ± 22.74 ml in the conventional dressing group (p = 0.34). Moreover, the average duration of drain placement for the pressure dressing group was 27.65 ± 9.86 hours, while it was 26.90 ± 11.23 hours for the conventional group (p = 0.83). Notably, there were no significant differences between the two groups regarding sialocele and pain scores. Furthermore, no complications from the application of pressure dressing were observed. Conclusions and RelevancePressure dressing does not provide significant benefits over conventional dressing after parotidectomy concerning drain output, duration of drain placement, or surgical complications.

Chitogel improves long-term health economic outcomes following endoscopic sinus surgery in severe chronic rhinosinusitis patients.

Chronic rhinosinusitis causes severe symptoms that can affect patient quality of life. Endoscopic sinus surgery can be effective in improving symptoms, although surgical outcomes can be compromised post-operatively, and revision surgery is required in a proportion of patients. This study compares outcomes and healthcare resource use in patients undergoing sinus surgery with or without Chitogel as a post-operative dressing. A retrospective cohort study was conducted using deidentified audit data from adult patients with severe chronic rhinosinusitis, who underwent endoscopic sinus surgery between January 2016 and December 2021. Patients in the intervention group received Chitogel as a post-operative dressing, and control patients received standard best-practice care. Cox Proportional Hazards survival analysis was used to compare revision surgery rates and time to revision between treatment groups. The rate of revision surgery was used to estimate potential health sector savings associated with use of Chitogel following surgery compared to the control arm, considering initial treatment costs and the cost of revision surgery. Over 18-24 months, patients treated with Chitogel demonstrated significantly lower rates of revision surgery (p = 0.035), and a trend towards decreased use of post-operative steroids, compared to control. Potential health sector savings due to reduced rates of revision surgery following use of Chitogel are estimated as NZ $753,000 per 100 patients. Severe chronic rhinosinusitis patients treated with Chitogel had lower rates of revision surgery within the first 18-24 months post-operative. These findings suggest that use of Chitogel can improve long-term patient outcomes and should improve health system efficiency.

Analgesic Efficacy of Oxycodone in Postoperative Dressings after Surgical Treatment of Burn Wounds: A Randomised Controlled Trial

Introduction: This study aimed to assess the analgesic efficacy of oxycodone at doses of 10 mg and 20 mg in dressings after surgery of burn wounds. Material and Methods: Twenty adult patients who underwent surgical treatment of third-degree burn wounds under general anaesthesia were included. Burn wounds were treated with dressings, to which oxycodone was added at 20 mg in Group 1 and 10 mg in Group 2. After the surgery, plasma oxycodone and noroxycodone concentrations were assayed, and pain intensity was assessed with Numerical Rating Scale (NRS). Results: In Group 1, no patient reported pain; in Group 2, four patients reported pain. The pain intensity, according to NRS, was 1–8. Plasma concentration of oxycodone in the blood serum was in the range of 1.24–3.15 ng/mL and 1.09–1.28 ng/mL in Group 1 and Group 2, respectively. Noroxycodone was not detected in the plasma. Adverse effects were not observed in any of the treated patients. Conclusions: Oxycodone in dressings provides patients with adequate and safe analgesia.

Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 2: The Translabyrinthine Approach).

Objectives Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesize the repair techniques and materials used in TL VS surgery to prevent CSF leaks. Design A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted. Results All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, postoperative dressings, and CSF diversion. The median postoperative incidence of CSF leaks was 6% (interquartile range: 0-10%). Conclusions This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that considers all operative stages described by our taxonomy.

Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 1: The Retrosigmoid Approach).

Objective Despite advances in skull-base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a common complication following retrosigmoid (RS) vestibular schwannoma (VS) surgery. We aimed to review and classify the available strategies used to prevent CSF leaks following RS VS surgery. Methods A systematic review, including studies of adults undergoing RS VS surgery since 2000, was conducted. Repair protocols were synthesized into a narrative summary, and a taxonomic classification of techniques and materials was produced. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were described. Results All 42 studies were case series, of which 34 were retrospective, and eight were prospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A repair taxonomy was produced considering seven distinct stages to CSF leak prevention, including intraoperative approaches to the dura, internal auditory canal (IAC), air cells, RS bony defect, extracranial soft tissue, postoperative dressings, and CSF diversion. Notably, there was significant heterogeneity among institutions, particularly in the dural and IAC stages. The median postoperative incidence of CSF leaks was 6.3% (IQR: 1.3-8.44%). Conclusions The intraoperative strategies used to prevent CSF leaks during RS VS surgery vary between and within institutions. As a result of this heterogeneity and inconsistent reporting of CSF leak predictive factors, a meaningful comparative analysis of repair protocols was not feasible. Instead, we propose the development of a prospective multicenter observational evaluation designed to accurately capture a comprehensive dataset of potential CSF risk factors, including all stages of the operative repair protocol.

Evaluation of the effectiveness of the use of modern self-adhesive silicone postoperative dressings

Introduction. When performing dressings on surgical patients, dressings must combine a barrier function and low trauma to the edges of the wound and surrounding skin. Target. To conduct a comparative assessment of the effectiveness of using adhesive- and silicone-based postoperative bandages. Material and methods. The study included 98 patients with postoperative wounds of the anterior abdominal wall after closure of intestinal stomas, laparotomies and minilaparotomies. In group I of patients (n = 50), new silicone-based dressings (Cosmopor silicone) were used. In group II patients (n = 48), adhesive bandages were used. The observation period was 10 days. We assessed the pain syndrome when removing the bandage, the presence of skin damage, the presence of subjective complaints of itching, burning, discomfort in the bandage area, and the number of purulent-septic complications.Results and discussion. When using silicone-based patch-type dressings, the number of patients with unsatisfactory skin condition decreased from 8 cases in the control group to 1 observation. The intensity of pain when removing the bandages decreased statistically significantly on the 6th and 9th days of observation in the main group – 0.8 ± 0.5 and 3.6 ± 1.0 points, respectively. Statistically significant differences were obtained in subjective complaints of discomfort and itching under the dressing material. The same number of purulentseptic complications in the form of suppuration of postoperative wounds in the comparison groups (χ2 = 0.002; p = 3.841) confirms that silicone-based dressings are not inferior in barrier function to adhesive-based dressings. Conclusion. Cosmopor silicone self-adhesive patch-type bandages on a silicone base improve the subjective sensations of patients, reduce the incidence of pathological conditions of the skin and wound surface, prevent increased pain during their removal, are applied for a longer period and do not affect the number of purulent-septic complications.

Auricular Protrusion After the Postauricular Approach: A Review of the Current Literature.

The postauricular approach is a widely adopted surgical technique for the ear due to its unique access to the middle ear, mastoid, and other internal structures, while adeptly concealing the surgical incision for aesthetic superiority. Despite its advantages, concerns have emerged regarding the potential for auricular protrusion following the procedure. While the exact mechanisms underlying this phenomenon remain under debate, it is worth noting that comprehensive literature on this topic is scant. Nevertheless, available studies predominantly indicate no association between the postauricular approach and lasting auricular protrusion. In the few reports that do note its occurrence, the protrusion appears transient, resolving over time. These findings suggest that surgeons should continue using the postauricular approach without concerns regarding auricular protrusion. Nonetheless, it is recommended to take all precautionary measures, including appropriate patient selection, engagement of an experienced surgeon, and meticulous postoperative dressing.

CARCINOMEEPIDERMOIDEDU SCALP:APROPOSDUNCASMULTI-COMPLIQUE.SQUAMOUSCELLCARCINOMAOFSCALP: ACASEREPORTOF APATIENT WITH MULTIPLE COMPLICATIONS

Squamous cell carcinoma of the scalp is frequent in our field of practice. Nevertheless, we report the case of a patient who had consulted at a locally advanced stage of the tumour. The patient was being monitored in our department and had almost all the critical complications of cancer in an elderly patient. Pathology examination confirmed the diagnosis. Treatment was dependent on the stage of the lesion and its location. The prognosis remained bleak. However, our hope for this patient relied on therapeutic protocols combining carcinological surgery first followed by adjuvant chemotherapy. This is a rather exceptional clinical case because of the multiple complications the patient had: 1. Thromboembolic 2. Infectious 3. Rapid tumor recurrence after 15 days 4. None cooperative patient due to inability to support post-operative dressings 5. Depressive disorders due to long length of hospitalization 6. Death The rarity of the combination of all these complications has caused us therapeutic problems. Therefore, we highlight the importance of screening and management of tumours at an early stage.

Superficial Surgical Site Infections in Primary Total Joint Arthroplasty: A Retrospective Analysis of Topical Anti-Biofilm Therapy.

Introduction Surgical site infections (SSI) following orthopedic procedures can cause significant morbidity and mortality, particularly in total joint arthroplasty. Biofilm formation in surgical wounds has made it difficult to prevent and treat these infections. SURGX® Antimicrobial Wound Gel (Next Science, Jacksonville, Florida, USA) was developed to disrupt biofilm formation but has not been evaluated in prophylactic use in total joint arthroplasty to prevent superficial SSI. Methods A retrospective chart review was performed at a single institution comparing the rate of SSI in patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). SSI data were collected from patients with standard postoperative dressings (Group A: Control) and patients with SURGX® applied as part of a standardized dressing following THA/TKA (Group B: Study). Rates of SSI were compared. Results SURGX® was administered to 120 patients, including 91 TKAs and 29 THAs. The overall infection rate in this cohort was 2.5%. No superficial site infections developed. The control group constituted 566 patients, with 386 TKAs and 180 THAs. The infection rate was 1.24%, which included one superficial infection. Binary logistic regression did not show different odds of developing infections with the use of SURGX® (OR = 2.23, 95% CI: 0.54-9.13, p=0.27). Conclusion In our small retrospective study, Next Science SURGX® Antimicrobial Wound Gel did not demonstrate a statistically significant difference in the rate of superficial SSI in total joint arthroplasty; however, Group B did not have any superficial SSI.

Reducing Surgical Site Infections with Silver-impregnated Dressings in Lower Extremity Bypass Patients

Surgical site infection (SSI) after lower extremity (LE) bypass surgery is associated with longer length of stay, higher hospital cost, increased morbidity, and even graft loss. Silver-impregnated dressings have been used by other surgical subspecialties to decrease SSI with reported success. The National Surgical Quality Improvement Program (NSQIP) published a national expected rate of 7.9% for SSI after LE bypass surgery. In 2018, our institutional SSI rate was 12.8%. To reduce this rate, we transitioned to silver-impregnated dressings for all LE bypass procedures and studied the subsequent impact on SSIs. We used NSQIP data to retrospectively study two consecutive cohorts of vascular surgery patients at a single institution who underwent LE bypasses. Patients in 2019 underwent the standard of care surgery with standard sterile gauze postoperative dressings. Patients in 2020 underwent standard of care surgery and were treated with silver-impregnated dressings. NSQIP criteria were used to determine if patients developed SSIs within 30 days of surgery. The Fischer exact and χ2 tests were used to compare groups before and after the intervention. A total of 282 patients underwent LE bypass in 2019 and 2020. The standard of care cohort had 168 patients with sterile gauze dressings, whereas the cohort after intervention had 114 patients with silver-impregnated dressings. The groups were similar in terms of demographics and comorbidities (Table). When considering all classifications of SSI, there were significantly fewer infections in the silver dressing group compared with the sterile gauze group (9.6 % vs 20.8%; P = .014). There was a non-statistically significant reduction in readmissions and unplanned return to the operating room in the silver dressing group. This study demonstrated a significantly lower rate of SSIs in patients undergoing LE bypass with use of a silver-impregnated dressing when compared with a sterile gauze dressing. Although our study does not demonstrate a causal relationship, this relatively inexpensive and low-risk intervention's association with a significant decrease in an otherwise very serious postoperative complication argues for a change in clinical practice or prospective confirmatory studies to optimize patient outcomes after LE bypass.TableDemographic and comorbidity differences between groups of patients who underwent lower extremity (LE) bypass surgery using sterile gauze dressing (2019) and silver-impregnated dressing (2020), and NSQIP-collected outcomes regarding postoperative surgical site infection (SSI), wound dehiscence, unplanned return to operating room, and readmission within 30 daysSterile gauze (n = 168)Silver dressing (n = 114)P-valueMale gender109 (64.8)79 (69.3).5Age, years67.1 (10.8)66.0 (11.2).4Race.7 Asian1 (0.6)2 (1.8) Black or African American25 (14.9)13 (11.4) Unknown11 (6.5)7 (6.1) White131 (78.0)92 (80.7)Emergent surgery10 (5.9)4 (3.5).4Active smoker78 (46.4)52 (45.6).9Diabetes.4 Yes, insulin-dependent47 (28.0)39 (34.2) Yes, non-insulin-dependent32 (19.1)23 (20.2) No89 (53.0)52 (45.6)Hypertension133 (79.2)93 (81.6).6Chronic obstructive pulmonary disease26 (15.5)15 (13.2).6Dialysis10 (5.9)10 (8.8).4Superficial SSI35 (20.8)11 (9.7).014Deep SSI5 (3.0)2 (1.8).7Organ space SSI2 (1.2)6 (5.3).07Wound dehiscence6 (3.6)5 (4.4).8Unplanned return to operating room43 (25.6)32 (28.1).7Readmission39 (23.2)30 (26.3).2Data are presented as mean (standard deviation) or number (%). Open table in a new tab

The Role of Postoperative Dressing in Hypospadias Surgery: A Systematic Review and Meta-analysis of the Pediatric Literature.

This study aimed to describe the available dressings and their management in patients undergoing hypospadias repair and compare postoperative outcomes with and without dressing and between the different dressing types. A comprehensive electronic literature search of PubMed, Embase, and Cochrane Library was conducted to obtain studies, published in the period 1990 to 2021, reporting on the dressing used following hypospadias surgery. All information regarding the dressing was considered as primary endpoints, whereas surgical outcomes were assessed as secondary outcomes. Thirty-one studies containing 1,790 subjects undergoing hypospadias repair were included. Dressings were divided into three categories: nonadherent to the wound, adherent to the wound, and glue-based dressings. Most authors preferred to remove/change the dressing in the ward and the median time of removal/change was 6.56 postoperative days. The dressing removal appeared as the most frequent factor generating parental anxiety. The median rate of wound-related complications was 8.18%, of urethroplasty complications 9.08% and of reoperations 8.18%. Meta-analysis of outcomes showed higher risk of reoperations using conventional dressing, with no differences in urethroplasty and wound-related complications rates between conventional and glue-based dressings. Furthermore, the use of dressing reported increased risk of wound-related complications compared with no dressing, without significant differences regarding occurrence of urethroplasty complications and reoperations. The current evidence confirmed that there is no difference in outcomes of hypospadias repair depending on a certain dressing type. To date, surgeon's preference remains the main factor determining the choice for a specific dressing or for no dressing at all.

Incisional Negative Pressure Wound Therapy Does Not Affect Deep Surgical Site Infection Rates in Neuromuscular Scoliosis Surgery.

Surgical site infection (SSI) is a devastating complication in patients with neuromuscular scoliosis (NMS) undergoing posterior spinal instrumented fusion (PSIF) for progressive scoliosis. Incisional negative pressure wound therapy (INPWT) has been used in other surgical fields to reduce SSI. Our purpose was to examine the prophylactic use of INPWT after NMS surgery to decrease SSI. At a single institution, 71 consecutive patients with NMS underwent PSIF from 2015 to 2019. Starting in 2017, all patients with NMS received INPWT postoperatively until discharge. Rates of deep SSI were compared between the two cohorts of patients. Additionally, patient demographic and operative factors such as American Society of Anesthesiologists score, number of levels instrumented, need for an anterior spinal release, need for spinal fusion to pelvis, blood loss, operative time, fluoroscopy time, length of stay, and transfusion requirement were analyzed for potential influence on deep SSI. There was no significant difference in deep SSI rates between patients who received INPWT (2 of 41) and those treated with a standard postoperative dressing (2 of 30; P=1.0). Although INPWT theoretically can stabilize the wound environment and prevent deep SSI, our findings do not support this. More research is needed to evaluate the efficacy of INPWT after PSIF for NMS. [Orthopedics. 2023;46(6):373-378.].

Efficacy of bioabsorbable dressing combined with antibacterial spray for treatment of third-degree burns.

To evaluate the clinical efficacy of a bioabsorbable dressing in combination with antibacterial spray in treating third-degree burns. Patients with third-degree burns in our hospital from February 2019 to February 2020 were enrolled and divided into an experimental group and a control group. In all patients, two wound repair surgeries were performed. During the first surgery, bioabsorbable dressing (PELNAC, Gunze Medical Equipment (Shenzhen) Co. Ltd., China) was used for wound treatment. During the second surgery, autologous split-thickness skin graft was performed. For patients in the experimental group, bioabsorbable dressings (PELNAC) were uniformly applied with antibacterial spray during the operation and during postoperative dressing. For patients in the control group, antibacterial spray was not used. A total of 68 patients took part in the study (experimental group n=36; control group n=32). Infection rate in the experimental group was significantly lower than that in the control group (2.8% versus 21.9%, respectively; p<0.05). The mean wound healing time in the experimental group was shorter by 3.2 days and the wound healing rate of the experimental group was significantly higher than that in the control group (p<0.05). Vancouver Scar Scale (VSS) scores at specific postoperative time intervals were significantly reduced in the experimental group compared with those in the control group (p<0.05). Bioabsorbable dressing combined with antibacterial spray could reduce infection rate, shorten wound healing time and reduce scar formation in repairing third-degree burns.

How to Decide Upon an Appropriate Post-Operative Dressing: 2022.

In the current era, there are numerous advanced postoperative dressings. The ideal postoperative dressing is one that is thought to improve patient comfort, manage postoperative drainage, potentially allow for visualization of the wound, improve postoperative healing, and possibly reduce bacterial invasion. However, many advanced surgical dressings have shown increased ease of handling and increased patient comfort, but have not shown true superiority with regard to objective criteria. To ease the overall evaluation of such products, we have categorized them as standard of care dressings, engineered dressings, antimicrobial engineered dressings, skin glues and adhesives, and closed incisional negative pressure wound therapy. Among these categories, closed incisional negative pressure wound therapy has repeatedly shown superior subjective and objective outcomes. However, due to cost constraints, this therapy is not ideal for everyone. In many cases, the postoperative dressing should be dictated by the type of surgery, the location of the surgery, and the comorbidities of the patient. The authors will review the appropriate indications for the use of all categories of postoperative dressing and identify specific items that have shown great promise. The current guidelines will also be reviewed.

A prospective clinical pilot study comparing two post-operative dressings in the treatment of surgical incisions in volunteers.

Surgical site infections (SSIs) are one of the leading causes of post-operative morbidity and mortality worldwide. The original post-operative dressing, gauze taped in place, did not protect the incision from contamination. A recent clinical trial demonstrated that transparent films were superior to gauze in reducing SSIs. Transparent films are semi-occlusive (semi-permeable, transparent). They protect the incision from contamination; however, one of the drawbacks of current films is that they may become dislodged during daily activities, such as showering. Patients may not realise that the integrity of the dressing has been compromised, leading to soiling of the incision and possible infection. DrySee (DrySee Inc., US) is a novel film dressing with a colorimetric indicator that alerts the patient when the dressing has been compromised. This trial compared the film dressing with the indicator (DSD) to a commonly used post-operative dressing comparator (Tegaderm + Pad; 3M, US). A 1.5cm incision was made in the volar forearm of volunteers. The incisions were randomly treated with the DSD or comparator dressing. A cohort of 20 volunteer patients was recruited. The DSD had a greater wear time and patients reported that the DSD dressing stayed in place better during activities compared to the comparator. Overall, 75% of patients preferred DSD and 25% preferred the comparator.

Reducing donor-site complications in DIEP flap breast reconstruction with closed incisional negative pressure therapy: A cost-benefit analysis

Deep inferior epigastric perforator (DIEP) flaps are considered the gold standard for autologous breast reconstruction but create large abdominal incisions that risk donor-site morbidity during harvest. Closed incision negative pressure therapy (ciNPT) is emerging as an effective alternative to standard postoperative dressings, but there is a paucity of data in DIEP flap donor sites. We conducted a retrospective case-control study investigating the use of ciNPT in DIEP flap donor sites at a single institution between March 2017 and September 2021. Patients who underwent microsurgical autologous breast reconstruction with DIEP flaps were included. Patients were divided into those with donor incision sites managed with ciNPT (n=24) and those with conventional postoperative wound dressings (n=20). We compared patient demographics, wound drainage volumes and postoperative outcomes between the two groups. A cost-benefit analysis was employed to compare the overall costs associated with each complication and differences in length of stay between the two groups. There was no statistically significant difference in age, body mass index (BMI), comorbidity burden or smoking status between the two groups. Both groups had similar lengths of stay and wound drainage volumes with no readmissions or reoperations in either group. There was a statistically significant reduction in donor-site complications (p=0.018), surgical site infections (p=0.014) and seroma formation (p=0.016) in those with ciNPT. Upon cost-benefit analysis, the ciNPT group had a mean reduction in cost-per-patient associated with postoperative complications of £420.77 (p=0.031) and £446.47 (p=0.049) when also accounting for postoperative length of stay CONCLUSION: ciNPT appears to be an effective alternative incision management system with the potential to improve complication rates and postoperative morbidity in DIEP flap donor sites. Our analysis demonstrates improved cost-benefit outweighing the increase in costs associated with ciNPT. We recommend a multicentre prospective trial with formal cost-utility analysis to strengthen these findings.