Dressing change frequency following anterior cruciate ligament reconstruction: a pilot study

Abstract

Dressings that are applied to surgical wounds at the time of surgery can either be removed early, changed regularly, or retained until the removal of sutures. Frequent dressing changes may lead to damage of the skin barrier which protects the body against infection. Additionally, this may cause an increased risk of complications due to the increased frequency of wound exposure. Dressing change has been reported as the most painful procedure associated with wounds. Pain contributes to stress and anxiety, consequently leading to potentially delayed healing. Moreover, dressing change, which may sometimes be traumatic and time consuming, seems to have great impact on patients’ quality of life. Moreover, the economic burden that arises from frequent dressing changes is not to be overlooked. Costeffective care practices and reduced expenditure on wound dressings are mandatory. Despite the importance of this issue regarding the frequency of the dressing change in surgical wounds, data in literature are limited. It has been reported that there were no significant differences between the early and delayed dressing removal group in the proportion of people who developed superficial surgical site infection. Additionally, a 7-day interval between changes of the negative pressure wound therapy (NPWT) is acceptable as compared to a 3-day one. However, there is no clear indication in literature about what the optimal time interval for dressing changes following anterior cruciate ligament reconstruction (ACLR) is. To address this issue, a pilot, clinical trial was designed to compare two different Abstract Background: Data in the literature are limited concerning the impact of different time scheduling, in regards to dressing change frequency, on infectious complications at the surgical site attributable to the dressing procedure itself. Methods: A pilot, randomized trial was conducted to assess the safety of two different dressing removal protocols performed after anterior cruciate ligament reconstruction for deficiency. Patients assigned to “standard” protocol underwent a dressing change on postoperative day 2, 4 and 6. Those assigned to the “revised” protocol underwent a change just on day 6. All patients’ surgical site skin was cultured at baseline and on postoperative day 6 immediately after dressing removal. Results: Forty patients were assigned to the “standard” protocol and forty to the “revised” one. The percentage of culture positive subjects was 2.5% (1/40) in the “standard” protocol group compared to 0% in the “revised” one. No significant differences were found in the number of positive culture subjects between methods. Conclusion: Changing dressing frequently doesn’t seem to provide any additional benefit to the patients, while retaining it doesn’t lead to any increased risk of infection. Moreover, the patient’s inconvenience and increased related cost caused by frequent dressing change suggest that the dressing should be retained for at least 6 days postoperatively. Level of evidence: 2b