Surgical wounds are covered to prevent bleeding, absorb exudate, and provide a barrier against external contamination. Usually, after orthopaedic surgery, a traditional occlusive dressing of sterile gauze and hypoallergenic non-woven tape is placed. In many cases, it has been observed the appearance of blisters caused by the use of these conventional dressings that may increase the risk of infection, pain and eventually the global cost of the procedure. There are other types of dressings available, that could improve these aspects, but no enough data is available. For this reason, we started a prospective and randomized study to compare five types of dressings used in total knee arthroplasty (TKA) and total hip arthroplasty (THA). The hypothesis was that any of the four preformed dressings studied would preserve the integrity of the skin better than the conventional dressing, and the main objective was to compare four types of preformed dressings with the conventional nonwoven dressing with the gauzes in terms of preservation of skin integrity. Likewise, the satisfaction of nurses was compared in terms of ease of application and removal as well as global assessment, using an ad hoc scale from 0 to 5. The intensity of pain reported by the patient (numerical scale 0-10) at the time of dressing removal and patient satisfaction in terms of mobility, convenience for hygiene, dressing/undressing, sitting and sleeping comfortably, and global assessment of the patient were measured using an ad hoc scale from 0 to 5. Subjects over 18 years of age who underwent elective THA or TKA by fast track, with the ability to give consent and answer the satisfaction questionnaires, were included in the study. Patients allergic to adhesive tape and with a dermatological history were excluded. The main variable was the percentage of patients with skin integrity (absence of blisters, erosion, erythema, maceration, swelling, wound dehiscence or purulent exudate) in the surgical wound, in the different wound cares performed until staple removal. The nursing staff made the assessments in each of the wound cares. Results: Of the 558 randomized subjects, 59.9% were women, with a mean age of 69.2 (SD 9.63) years, 17.6% (98) had diabetes mellitus (DM) and the mean body mass index (BMI) was 31.03 kg/m2. 72.9% (407) underwent TKA and 27.1% (151) THA. The dressing that best preserved the integrity of the skin was Opsite®, with 90.3% of the subjects with intact skin, and the worst was the conventional one, with 73.8%. Regarding the evaluation of the different dressings by the professionals, the results show that, in the operating room, the conventional dressing was the best valued. On the contrary, in the evaluations of the professionals in the different wound cares, the conventional dressing was less valued than the majority of preformed dressings. Pain on removal of the dressing was mild in most cases, with the conventional dressing having the highest pain scores. Regarding the assessments of mobility, sitting, convenience for hygiene, dressing/undressing, and comfort for rest and sleep, Opsite® obtained the best scores. The dressing that obtained the highest degree of patient satisfaction was Opsite® with an average score of 4.70 In conclusion, the results of this randomized study show that Opsite® preserves skin integrity better than the conventional dressing and was also the one that, in general, obtained the best results in the evaluation of the professionals and the satisfaction of the subjects.
| Date of Award | 29 Nov 2022 |
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| Original language | Spanish |
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| Awarding Institution | - Universitat Autònoma de Barcelona (UAB)
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| Supervisor | Roser Vives Vilagut (Director), Mònica Sianes Gallén (Director) & Caridad Pontes Garcia (Tutor) |
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