Early Versus Delayed Dressing Removal in Clean-Contaminated and Contaminated Midline Laparotomy Wounds

Roshina  Alam; Farhat  Jaleel; Tasneem Shabbir  Siamwala; . Maria; Qurat-Ul-Ain  Akram; Akram  Rajput

doi:10.54112/bcsrj.v6i6.1951

Authors

Roshina Alam Department of Surgical Unit 3, Civil Hospital Karachi, Pakistan
Farhat Jaleel Department of Surgical Unit 3, DUHS, Pakistan
Tasneem Shabbir Siamwala Department of Surgical Unit 3, Civil Hospital Karachi, Pakistan
. Maria Department of Surgical Unit 3, Civil Hospital Karachi, Pakistan
Qurat-Ul-Ain Akram Department of Surgical Unit 3, Civil Hospital Karachi, Pakistan
Akram Rajput Department of Surgical Unit 3, DUHS, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.1951

Keywords:

Early and late dressing removal, SSI, midline laparotomy, complications

Abstract

Surgical site infections (SSIs) remain a major postoperative complication associated with increased morbidity, prolonged hospital stay, and additional healthcare costs. Optimal timing for removal of surgical dressings after midline laparotomy remains debated, particularly in clean and clean-contaminated wounds. Objective: The purpose of this research was to assess whether patients who receive their dressings removed earlier develop fewer superficial SSIs after undergoing midline laparotomy surgery. Methods: After obtaining ethical approval from the institutional review board, this randomised controlled trial was conducted at the Department of General Surgery, Dr. Ruth K.M. PFAU Civil Hospital, Karachi, from 1 July 2024 to 30 December 2024. Through non-probability consecutive sampling, 94 patients aged 18 to 60 years, both genders, admitted for either elective or emergency surgeries, who underwent midline laparotomy procedures with wounds either clean or clean-contaminated wounds were included in the present study. Results: A significant difference was observed in the incidence of superficial surgical site infection (SSI) between the two groups. 64% of patients in the early dressing removal group developed SSIs compared to 85% in the late removal group, indicating a statistically significant reduction in SSIs with early dressing removal (p = 0.02). This finding supports the hypothesis that early dressing removal may contribute to improved postoperative wound outcomes. Conclusion: Early removal of dressing after midline laparotomy within 48 hours has a lower incidence of superficial surgical site infections than delayed removal.

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References

Gashaw A, Fantu S, Tarekegn M. Factors associated with surgical site infection of women who underwent cesarean section in Hawassa University comprehensive specialized hospital, southern Ethiopia, retrospective study design. Int J Surg Open. 2022;44:100506. https://doi.org/10.1016/j.ijso.2022.100506

Costabella F, Patel KB, Adepoju AV, Singh P, Attia Hussein Mahmoud H, Zafar A, et al. Healthcare costs and outcomes associated with surgical site infection and patient outcomes in low- and middle-income countries. Cureus. 2023;15(7):e42493. https://doi.org/10.7759/cureus.42493

Sinha S. Management of post-surgical wounds in general practice. Aust J Gen Pract. 2019;48(9):596–9. https://doi.org/10.31128/AJGP-04-19-4921

Kvist M, Jensen TK, Snitkjær C, Burcharth J. The clinical consequences of burst abdomen after emergency midline laparotomy: a prospective, observational cohort study. Hernia. 2024;28(5):1861–70. https://doi.org/10.1007/s10029-024-03104-x

Hrynyshyn A, Simões M, Borges A. Biofilms in surgical site infections: recent advances and novel prevention and eradication strategies. Antibiotics (Basel). 2022;11(1):69. https://doi.org/10.3390/antibiotics11010069

Nandan MP, Darshan AM, Prasad P. Early versus delayed dressing removal after primary closure of clean and clean-contaminated wounds: an observational study. Int Surg J. 2024;11(8):1288–91. https://doi.org/10.18203/2349-2902.isj20242773

Laurano R, Boffito M, Ciardelli G, Chiono V. Wound dressing products: a translational investigation from the bench to the market. Eng Regen. 2022;3(2):182–200. https://doi.org/10.1016/j.engreg.2022.04.002

Zhang T, Zhang F, Chen Z, Cheng X. Comparison of early and delayed removal of dressing following primary closure of clean and contaminated surgical wounds: a systematic review and meta-analysis of randomized controlled trials. Exp Ther Med. 2020;19(5):3219–26. https://doi.org/10.3892/etm.2020.8591

Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, et al. A proposal for a comprehensive approach to infections across the surgical pathway. World J Emerg Surg. 2020;15(1):13. https://doi.org/10.1186/s13017-020-00295-3

Hawthorne B, Simmons JK, Stuart B, Tung R, Zamierowski DS, Mellott AJ. Enhancing wound healing dressing development through interdisciplinary collaboration. J Biomed Mater Res B Appl Biomater. 2021;109(12):1967–85. https://doi.org/10.1002/jbm.b.34861

Funari R, Shen AQ. Detection and characterization of bacterial biofilms and biofilm-based sensors. ACS Sens. 2022;7(2):347–57. https://doi.org/10.1021/acssensors.1c02722

Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, et al. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev. 2016;12(12):CD003091. https://doi.org/10.1002/14651858.CD003091.pub4

Al-Sulaitti Z, Nelakuditi B, Dandamudi BJ, Dimaano KAM, Shah N, AlQassab O, et al. Impact of early dressing removal after cesarean section on wound healing and complications: a systematic review. Cureus. 2024;16(9):e70494. https://doi.org/10.7759/cureus.70494

Subramaniam A, Jauk V, Saade G, Boggess K, Longo S, Clark EAS, et al. The association of cesarean skin incision length and postoperative wound complications. Am J Perinatol. 2022;39(5):539–45.