There is insufficient evidence to know whether dressings reduce the risk of wound infection after surgery and, in some cases, leaving a wound exposed may be better, say researchers in The BMJ today.
A recent Cochrane review of trials on the use of dressings to prevent surgical site infection found insufficient evidence to conclude which type of dressing reduced infection or whether dressings were needed at all.
The review concluded that, because of the lack of evidence, current decision making about dressings may need to be led by practical issues, such as wound symptom management and costs, rather than surgical site infection.
So what are the practical issues and costs of wound dressings versus no dressing?
Dressings absorb exudates and provide a barrier to being directly knocked or caught on something, they explain. They may reduce patient anxiety by covering the incision.
Leaving a wound exposed without a dressing, however, may aid prompt assessment of an impending problem and allay fears of what might be underneath the dressing.
Not covering a closed wound after surgery may be especially important in children because it avoids the need for painful removal of dressings.
In terms of cost, these vary greatly, from inexpensive basic wound contact dressings (a few pence each) to expensive advanced dressings (such as antimicrobial dressings) which may cost between £10 and £20 each.
In light of this uncertainty, the authors recommend the use of basic, low-absorbency dressings at a cost of a few pence per dressing.
However, in specialties where it is common practice to not use dressings -- and in paediatric surgery, if the removal of dressings causes undue distress to children -- they suggest continuing with this practice until further evidence emerges.
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Journal
The BMJ