Effect of three wound dressings on infection, healing comfort, and cost in patients with sternotomy wounds: a randomized trial. Choice of dressing has a major impact on blistering and healing outcomes in orthopaedic patients. Randomized trial comparing cryopreserved cultured epidermal allografts with hydrocolloid dressings in healing chronic venous ulcers. Influence of occlusive and impregnated gauze dressings on incisional healing: a prospective, randomized, controlled study. A prospective randomized evaluation of negative-pressure wound dressings for diabetic foot wounds. Comparative study of leg wound skin closure in coronary artery bypass graft operations. A silver-coated antimicrobial barrier dressing used postoperatively on meshed autografts: a dressing comparison study. A comparison of three wound dressings in patients undergoing heart surgery. A prospective randomized trial comparing subatmospheric wound therapy with a sealed gauze dressing and the standard vacuum-assisted closure device.
To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness.
                Prospective, randomized controlled trial.
                Major metropolitan, academically affiliated, tertiary referral center.
                Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith & Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith & Nephew] in the operating theater on skin closure.
                There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p < 0.001), poor dressing integrity (p < 0.001), more frequent dressing changes (p < 0.001), more discomfort with removal (p < 0.05), and increased cost (p < 0.001).
                In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery. To investigate the effect of three postoperative dressings on orthopaedic wound healing.
                Three hundred orthopaedic patients were divided into three treatment groups and allocated to management with one of three dressings: Primapore, Tegaderm with pad, and OpSite Post-Op. Staff completed a questionnaire to evaluate the wound progression. Outcome measures were the presence of infection, blistering and the number of dressing changes required.
                There was a significantly lower incidence of blistering with OpSite Post-Op (6%) than Tegaderm with pad (16%) and Primapore (24%) (p<0.001). Patients in the OpSite Post-Op group had the lowest exudate levels.
                Dressings that employ a clear film and have a high moisture vapour transmission rate have been shown to reduce both the rate of blistering and wound discharge. The additional expense inherent in using such dressings may, in reality, prove cost-effective because of the reduced need for dressings changes and the subsequent earlier discharge of these patients from hospital with an uncomplicated wound. Cultured epidermal allografts have been successfully used to treat a variety of wounds. Their postulated mechanism of action is through release of cytokines that stimulate epithelialization. On the basis of previous experience we expected ulcers treated with cryopreserved cultured allografts (CCAs) to be healed by 6 weeks. Hydrocolloid dressings (HCDs) have also been reported to be effective in the treatment of venous ulcers.
                Our purpose was to compare the effectiveness of CCAs with HCDs in healing chronic venous ulcers.
                Forty-three patients with 47 ulcers were enrolled in a randomized controlled trial. Ulcers not healed by 6 weeks were changed to the other treatment.
                No difference in the number of healed ulcers between the two groups was observed at 6 weeks. Healing rate, percent reduction of initial ulcer size, and radial progression toward wound closure were significantly greater for CCAs than for HCDs. Pain relief was not significantly different.
                CCAs achieve more rapid healing and greater reduction in ulcer size than HCDs. After elective surgery, 28 patients with 40 wounds were enrolled in a controlled clinical study to assess the effects of two different dressings on incisional healing. Patients served as their own control with one-half of each incision covered with an impregnated gauze (Xeroform) and the other half of the incision covered with a thin occlusive hydrocolloid dressing (DuoDerm Extra Thin CGF). All wounds were evaluated 2 to 3 days, 7 to 10 days, 4 weeks, and 7 months postoperatively. None of the incisions segments showed any evidence of infection. At the time of suture removal, the hydrocolloid dressing's ability to contain exudate, protect the wound, and facilitate mobility and personal hygiene were rated higher compared with the gauze-type dressing (p < 0.001, for all variables). At the 4-week visit, both the patient and the surgeon rated the scar segments covered with the hydrocolloid dressing better with respect to color, evenness, and suppleness (p < or = 0.04, for all variables). These differences were no longer apparent 7 months after surgery. Optimal treatment for large diabetic foot wounds is ill defined. The purpose of this study was to compare the rate of wound healing with the Vacuum Assisted Closure device trade mark (VAC) to conventional moist dressings in the treatment of large diabetic foot wounds. Diabetics with significant soft tissue defects of the foot were considered for enrollment. Patients were randomized to receive either moist gauze dressings or VAC treatments for 2 weeks, after which they were treated with the alternative dressing for an additional 2 weeks. Wounds were photographed weekly and wound dimensions calculated in a blinded fashion with spatial analysis software. Percent change in wound dimensions were calculated and compared for each weekly assessment and over 2 weeks of therapy with each dressing type. Ten patients were enrolled in the trial, but two were lost to follow-up and two were withdrawn. Complete data were available for analysis on seven wounds in six patients. Average length, width, and depth of the wounds at initiation of the trial was 7.7, 3.5, and 3.1 cm, respectively. Only the wound depth was significantly decreased over the weeks of the trial to 1.2 cm ( p < 0.05). VAC dressings decreased the wound volume and depth significantly more than moist gauze dressings (59% vs. 0% and 49% vs. 8%, respectively). VAC dressings were associated with a decrease in all wound dimensions while wound length and width increased with moist dressings. In summary, over the first several weeks of therapy, VAC dressings decreased wound depth and volume more effectively than moist gauze dressings. Negative-pressure wound treatment may accelerate closure of large foot wounds in the diabetic patient. A prospective randomised study of four different methods of leg wound skin closure after removal of the long saphenous vein was carried out in 113 patients undergoing coronary artery bypass grafting. These methods were: (1) continuous nylon vertical mattress suture (27 patients); (2) continuous subcuticular absorbable (Dexon) suture (29 patients); (3) metal skin staples (Autosuture) (27 patients); and (4) adhesive sutureless skin closure ("Op-site") (30 patients). All wounds were examined by two independent observers at five, 10, and 45 days after operation. At five days, inflammation, extent of oedema, discharge, and infection were assessed. At 10 days attention was paid to the state of wound healing and at 45 days to the final cosmetic appearance. The use of continuous subcuticular suture resulted in significantly less discharge than did the use of metal staples, nylon vertical mattress suture, or Op-site. The incidence of established wound infection was 4.5% overall, with no infection in the wounds closed with Dexon. Assessment of the healing process showed subcuticular Dexon to be more effective than metal staples or vertical mattress nylon suture. The final cosmetic result showed continuous subcuticular suture to be superior to nylon vertical mattress suture and skin staples but as effective as Op-site sutureless skin closure. In an effort to optimize the management of freshly grafted burn wounds, a silver-coated, low-adherence dressing, Acticoat (Smith & Nephew Inc., Largo, FL), was compared with 5% sulfamylon-soaked Exu-Dry burn wound dressings. Twenty subjects admitted to the Loyola University Medical Center were randomized to either Acticoat dressings or 5% sulfamylon-soaked burn wound dressings. Dressings were applied immediately after grafting in the operating room. Acticoat dressings were left in place for 3 days and then changed every 3 days thereafter. Sulfamylon-soaked dressings were changed at 48 hours and then every day. Subjects continued to have dressing changes on a twice-daily basis to wounds that were not grafted managed. Subjects were assessed for graft take, time to wound healing, and the number of dressings required until healing. Hospital charges and labor costs were retrospectively tabulated, yielding an expense estimate for each group. There were no significant differences between the two groups with respect to age, %TBSA, %TBSA of the grafted test sites, graft take, time to graft healing, or infectious complications. The median number of dressing changes to the test site was significantly less in the Acticoat group (P < .05). The average expense per dressing change was not significantly different between the two groups; however, the average total expense per patient was significantly lower for the Acticoat group because of the reduced number of dressing changes. Acticoat and 5% sulfamylon-soaked burn wound dressings were equivalent with respect to wound healing and infectious complications. The use of Acticoat was found to be a safe alternative to the use of 5% sulfamylon as a postsurgical dressing in this group of subjects. Because of the reduced number of dressing changes, the use of Acticoat was a less expensive alternative to 5% sulfamylon dressing changes in this study. Two hundred fifty patients undergoing heart surgery were randomized in a prospective comparative study of a semiocclusive hydroactive wound dressing, an occlusive hydrocolloid dressing, and a conventional absorbent dressing. The wounds were evaluated during the 4 weeks after surgery. Color photographs were used for a blind evaluation of wound healing. The conventional absorbent dressing was more effective in wound healing, compared with the hydroactive dressing. Further, there were fewer skin changes and less redness in the wounds with the conventional dressing than with the hydroactive dressing; the differences were not significant with the hydrocolloid dressing. The conventional dressing was less painful to remove than the hydroactive and hydrocolloid dressings. More frequent dressing changes, however, were needed when using the conventional dressing. Despite this, it was the least expensive alternative. Two methods of subatmospheric pressure wound therapy--wall suction applied to a sealed gauze dressing (GSUC) and the vacuum-assisted closure device (VAC)--were compared in hospitalized patients at University of Chicago Medical Center.
                VAC therapy is widely used, but can be expensive and difficult to apply; it also fails in some patients.
                A randomized prospective study of 87 patients (N = 45 in the GSUC arm and N = 42 in the VAC arm) was undertaken between October 2006 and May 2008. The study comprised patients with acute wounds resulting from trauma, dehiscence, or surgery.
                Demographics and wound characteristics were similar in both groups. There were significant reductions in wound surface area and volume in each group. In the GSUC group, the reductions in wound surface area and volume were 4.5%/day and 8.4%/day, respectively (P < 0.001 for both), and in the VAC group, this was 4.9%/day and 9.8%/day, respectively (P < 0.001 for both). The reductions in wound surface area and volume were similar in both groups (P = 0.60 and 0.19, respectively, for the group-by-time interaction). The estimated difference (VAC - GSUC) was 0.4% (95% confidence interval: -1.0, 1.7) for wound surface area and 1.4% (95% confidence interval: -0.7, 3.5) for volume. The mean cost per day for GSUC therapy was $4.22 versus $96.51 for VAC therapy (P < 0.01) and the average time required for a GSUC dressing change was 19 minutes versus 31 minutes for a VAC dressing change (P < 0.01). The sum of pain intensity differences was 0.50 in the GSUC group compared with 1.73 for the VAC group (P = 0.02).
                GSUC is noninferior to VAC with respect to changes in wound volume and surface area in an acute care setting. In addition, GSUC dressings were easier to apply, less expensive, and less painful.
At present, there is no evidence to suggest that covering surgical wounds healing by primary intention with wound dressings reduces the risk of SSI or that any particular wound dressing is more effective than others in reducing the rates of SSI, improving scarring, pain control, patient acceptability or ease of dressing removal. Most trials in this review were small and of poor quality at high or unclear risk of bias. However, based on the current evidence, we conclude that decisions on wound dressing should be based on dressing costs and the symptom management properties offered by each dressing type e.g. exudate management.