While most surgical incisions are closed with stitches or staples,
some cannot be closed if skin edges do not align or there is a high
risk of infection, the authors explain. These incisions are left
open to heal, which can take longer and be more painful and require
regular dressing changes.
Open surgical wounds are said to heal by secondary intention rather
than primary intention like a closed wound.
“Currently, there is very little information available on how many
people have wounds healing in this way, or what proportion of
surgeries result in a wound healing by secondary intention,” said
lead author Gill Norman of the University of Manchester in the U.K.
One recent U.K. study estimated that four out of every 10,000 adults
were currently living with a wound of this type, and that for two of
these individuals this was the planned course of treatment, Norman
told Reuters Health by email.
The reviewers examined 11 randomized trials of topical or systemic
antibiotic or antiseptic use on secondary intention surgical wounds
conducted between 1998 and 2013. They included a total of more than
800 patients, with three trials in children.
Three trials were conducted in the U.S., two in Italy, and the rest
in other European countries, Asia or Africa. Four compared
antiseptic treatment to other treatment with no antimicrobials, four
studied alternative antimicrobial options and three compared
management with versus without antimicrobial agents.
There was moderate evidence that a topical antibiotic cream may
increase the chance of healing three weeks after hemorrhoid surgery
compared with a nonantibiotic cream, but low-quality evidence that
other antibiotic or antiseptic wound management would decrease time
to healing, increase number of wounds healed, decrease adverse
events or infection, as reported in the September 28 JAMA
Dermatology summary of the Cochrane review.
But the reviewed studies were small and often poorly reported, and
the interventions they examined may not accurately reflect current
clinical practice, the authors note.
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“Research has been conducted talking to people with these open
wounds and this highlights the shock and anguish that these wounds
can cause people, as well as the feeling of frustration and
powerlessness felt when living with them,” Norman said.
Since there is no reliable evidence that antibiotic or antiseptics
are helpful, decision makers will draw on national and local
guidelines, by the cost and availability of some treatments, the
safety data they have available to them and/or personal or patient
preference, she said.
There is also uncertainty surrounding other treatments for open
wounds, like negative pressure wound therapy and different types of
dressings, she said. Negative pressure therapy involves the
application of a wound dressing through which a vacuum is applied,
with any wound and tissue fluid that is drawn away from the area
being collected in a canister.
“It is important to note that, whilst further randomized controlled
trials in the field are required, they should be of high quality
using methodology that minimizes bias,” Norman said.
JAMA Dermatol 2016.
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