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Three Part Question

In [patients who have received suturing over their scalp wounds] are [covered dressings better than uncovered dressings] in [preventing wound infection]?

Search Strategy

MEDLINE [electronic resource]
/National Library of Medicine
Bethesda, Md. : National Library of Medicine [1965]-

The details of the search are as follows:

1st
[surgical OR wound$ OR suture OR laceration$ OR closure OR repair ti.] AND [dressing OR no OR early OR removal ti.] AND [randomized controlled trial pt.]

2nd
[surgical OR wound$ OR suture OR laceration$ OR closure OR repair ti.] AND [wet OR wash ti.]

LIMIT to human and english language
Limiters - English Language; Human
Expanders - Apply related words
Search modes - Find any of my search terms
PT randomized controlled trial

Search Outcome

1st
Total 627 papers have been generated
only 4 of them are relevant

2nd
Total 54 papers have been generated
only 1 of them are relevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Clare Heal 24 April 2006 UK	Patients who need minor skin excision. In the dry group: dressing were kept dry for 48 hours. Bathing and undressing were allowed afterwards until the removal of stitches. In the wet group: dressings were taken off within 12 hours. Bathing was allowed afterwards until the removal of stitches.	Prospective randomised controlled trial.	The infection rate	The infection rate in the intervention group was 8.4%. While, in the control group, it was 8.9%, P<0.5, one sides 95% confidence interval for the difference of infection was 0.028.	The general practitioners were younger which was not representative enough for the whole population. The climate was hot and humid, increasing sweat production and wet dressings. Thus, the covered control group was more prone to infection.
David Peleg September 2016 US	Women aged 18-44 years old at term with singleton pregnancies. They had scheduled nonlabored primary, first repeat, or second repeat cesarean delivery.	a randomized controlled trial. In the control group: wound dressings were removed 24 hours post-surgery. In the intervention group: wound dressings were removed 6 hours post-surgery.	Incidence of wound complications including, infection, dehiscence and hematoma. Patients' satifaction.	Similar incidence of wound complication in the control (12.5%) and the intervention group (13.8%) with 95% CI. In intervention group, 75.6% were pleased and satisfied. In control group, this was 56.9% with odds ratio 2.34, confidence interval 1.46-3.79)	This study did not compare the long term effect on scar appearance and late complications. Besides, this study was unblinded and the surgical techniques were not controlled. The questionnaire on patients' satisfaction was invalidated.
Chrintz, H February, 1989 Denmark	Patients were with clean or clear contaminated surgical wounds aged older than 3 years of age. The control group: sterile dressing were applied to the wound until the removal of the stitches. The intervention group: sterile dressings were applied during first 24 hours and would be removed afterwards.	prospective and randomized experimental study.	Incidence of infection.	In control group, 4.9% of the patients got wound infected. In intervention group, 4.7% of them got infected.
Gbolahan, O. O. ; Ogunmuyiwa, S. A. ; Osinaike, B. B. July, 2015 Nigeria	40 pediatric and adult patients who required cleft lip repair were randomized into group A and group B. In group A, genticin ointment nd dry gauze were applied and help in place in first 72 hours. In group B, only gauze dressings were applied in the first 6 hours postoperatively.	a randomized controlled trial.	The infection rate. Wound dehiscence.	The infection rate in group A was 0%. While in group, this was 2.5%. This finding was similar to previous reports (0-2.6%).Wound dehiscence noted in group A was 15%. While in group B, this was 20%.	The sample size in this study was samll.
Merei, J. M. December, 2004 Jordan	Pediatric patients who required surgical incision would be randomly assigned into group A (receiving dressing after completion of wound closure) or group B (not receiving any dressing after wound closure.	Randomized controlled study.	The infection rate.	In group A, the infection rate was 1.4%. While in group B, the infection rate was 1.7%. There was no significant difference, P<0.05).

Comment(s)

Conventionally, patients with sutured scalp laceration wound are advised to keep their wound and dressing dry for 48 hours. Gentle hair washing is allowed after 48 hours. Wound cleansing and dressing should be done afterwards until the removal of stitches. For sutured forehead laceration, patients are advised to keep their wound and dressing dry most of the time. Dressing should be done few days afterwards or when necessary until the removal of stitches. No washing is suggested. Some patients complained pain while changing their dressing and scalp itchiness if their wounds were covered. They felt comfortable if they were allowed to expose the wound to the air and have their hair washed. Dressings are inconvenient and bulky sometimes. In fact, several randomized controlled studies showed that there were no significant differences in the infection rate between early and delayed removal of covered dressing. For cleft lip repairing, dressing or not has no influence on dehiscence or scar quality (Gbolahan, et al., 2015). A controlled study suggested that routine bathing and washing after wound closure for 8 hours has no effect on wound healing and infection (Goldberg et al., 1981). Besides, wounds in head and face have less risk of getting infected since they are extremely vascular (Trott, 2012). Scab formed after suturing acts like a cover against foreign bodies (Merei, 2004). Therefore, sutured lacerations can be left open without dressing (Trott, 2012). Exposing the sutured wound without dressings covered could be beneficial in several ways. First of all, wounds could be examined easily which is especially important for children who may get anxious upon removal of dressing. Secondly, it facilitates wound hygiene. Patients could take shower in a convenient way without worried about damping the dressings. Besides, it reduces the nursing times to change the dressing and reduces the use of unnecessary dressing materials.

Clinical Bottom Line

The randomized controlled trials showed that covered dressings to reduce the rate of wound infection was not statically significant compared to uncovered dressings. For clean or clean contaminated sutured wounds, covered dressings are not necessary. Exposing these wounds would not increase the infection rate. On the contrary, it promotes wound hygiene and patients' satisfaction.

References

1. Clare Heal, Petra Buettner, Beverly Raasch, Sheldon Browning, David Graham, Rachel Bidgood, Margaret Campbell, Robert Cruikshank Can sutures get wet? Prospective randomised controlled trial of wound management in general practice British Medical Journal Publishing Group 24 April 2006; p.1053-19
2. David P., Esther E., Steven L. W., Nadav C. and Inbar B. S. Early wound dressing removal after scheduled cesarean delivery: a randomized controlled trial United States: Elsevier Inc September 2016; p.388
3. Chrintz, H ; Vibits, H ; Cordtz, T. O ; Harreby, J. S ; Waaddegaard, P ; Larsen, S. O Need for surgical wound dressing Bristol: John Wiley & Sons, Ltd February, 1989, p.204-205
4. Gbolahan, O. O. ; Ogunmuyiwa, S. A. ; Osinaike, B. B. Randomized Controlled Trial comparing Dressing and No Dressing of Surgical Wound after Cleft Lip Repair The Journal of Contemporary Dental Practice July, 2015: p.554-558
5. Merei, J. M. Pediatric Clean Surgical Wounds: Is Dressing Necessary? Elsevier Inc December, 2004; p. 1871-1873