Objective : To compare the evolution of the operative site in the presence or absence of an occlusive skin dressing. Patients and methods: Prospective, comparative study that took place at the University Hospital of Brazzaville from January 1st to August 31st, 2016. 120 patients were randomly recruited divided into two groups: A study group consisting of 60 patients without a dressing and a control group consisting of 60 patients. Results: Sociodemographic characteristics were similar in both groups, as well as pre- and intraoperative characteristics. Postoperative complications included parietal infection (3 vs . 4 cases, p > 0.05), one case of disunion, and one case of skin irritation by the plaster in the study group. The duration of healing was shorter in the control group compared to the study group (11 ± 2 days vs . 12 ± 2, p > 0.05). The average cost of care equipment was 3.5 times higher for the group with dressing (5120 FCFA vs . 18620 FCFA, p < 0.05). In the study group, only one patient was afraid of seeing her wound. Patients in the control group were less satisfied, indeed they dreaded the time of removal of the plaster because of the pain .
In gynaecological and obstetrical surgery, empirical hospital practice requires that after surgery of the abdomen, the operative site is covered by an occlusive skin dressing. A protective role against trauma and surrounding microbial flora is assigned to the dressing [
However, this practice has not been validated scientifically and would be questioned by some authors [
In Congo, no study has been done on this subject. Thus, a first preliminary study is carried out with the aim of contributing to the improvement of knowledge on the management of the operating site.
The objective of this work is to compare the evolution and the cost of the surgical wound in the presence or absence of an occlusive skin dressing.
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This was a randomized study carried out after a favourable opinion of the ethics committee, at the CHU of Brazzaville from January 1st to August 31st, 2016. It concerned the gynaecological and obstetric interventions performed in the department and meeting the following inclusion criteria: scheduled or emergency abdominal surgery, ASA score of 1 or 2 for scheduled patients, informed consent. We did not include women who underwent laparoscopic surgery for pelvic peritonitis and pelvic abscess.
The sampling consisted of two groups by randomly matching each uncovered dressing to a covered dressing, which resulted in the formation of two groups with two separate protocols:
- Study group: The surgical wound was not covered from the operating room, after painting of the latter with a compress soaked in povidone iodine dermal. The patient was seen every 48 hours for a brushing and a follow-up of the wound until the external clinical cicatrisation.
- Control group: the operative wound was covered by an occlusive skin dressing from the operating room after suture. The occlusive skin dressing was made of compresses impregnated with povidone iodine dermic covered by plaster. It was renewed on the 4th postoperative day and systematically every 48 h until the external clinical scarring.
The last control of the operative wound was performed on the 30th postoperative day.
For each patient we evaluated the general characteristics, the variables per and post-operative.
The data has been validated after evaluation and input using the Excel 2007 and SPSS software on WINDOWS version 0.
Descriptive statistics presented qualitative variables in proportions (%) and continuous variables in mean + standard deviation.
Statistical inference used the various parametric tests after univariate analyses.
Comparison of percentages used the Pearson Chi-square test and that of the t-Student averages.
The value of p < 0.05 was considered a threshold of statistical significance.
Patients with bandages had a mean age like their no-dressing counterparts (34 ± 1 years vs. 34 ± 2 years, NS p > 0.05).
No significant difference was observed between patients with dressing and those without dressing, in terms of education, marital status and occupation (p > 0.05) (
No significant difference was observed between the dressing group and the dressing-less group with respect to operative indication, operator qualification, laparotomy programming, and type of anaesthesia (p > 0.05) (
The mean laparotomy duration was similar in both groups (57.9 ± 24.5 minutes vs. 62.4 ± 27 minutes, p > 0.05).
The type of skin incision, the nature of the cutaneous suture and the use of blood transfusion were identical between the two groups (
Patients with occlusive skin dressings had a longer average healing time than their non-bandaged counterparts (12 ± 2 days vs. 11 ± 2 days, p > 0.05) (
| Occlusive dressing N (%) | |||
|---|---|---|---|
| With | Without | P value | |
| Age | 34 ± 9 | 34 ± 8 | 0,721 (NS) |
| schooling | 59 (50) | 59 (50) | |
| ・ Educated | 1 (50) | 1 (50) | |
| ・ None-educated | |||
| Marital status | |||
| ・ Single | 25 (51) | 24 (49) | 0,169 (NS) |
| ・ Married | 33 (49,3) | 34 (50,7) | |
| ・ Divorced | 1 (33,3) | 2 (66,7) | |
| ・ Widow | 0 (0) | 1 (100) | |
| Profession | |||
| ・ Employee | 21 (50) | 21 (50 | 0,576 (NS) |
| ・ Unemployed | 39 (50) | 39 (50) | |
| Occlusive dressing N (%) | |||
|---|---|---|---|
| With | Without | P value | |
| Indication of laparotomy | |||
| ・ Caesarean | 32 (50) | 32 (50) | 0,382 (NS) |
| ・ Myomectomy | 9 (39,1) | 14 (60,9) | |
| ・ Ectopic pregnancy | 5 (83,3) | 1 (16,7) | |
| ・ Cystectomy | 4 (40) | 6 (60) | |
| ・ Hysterectomy | 9 (52,9) | 8 (47,1) | |
| Qualification of the operator | |||
| § Graduate gynaecologist | 31 (46,3) | 36 (53,7) | 0,231 (NS) |
| § Student in training | 29 (54,7) | 24 (45,3) | |
| Programming of laparotomy | |||
| ・ Scheduled | 29 (45,3) | 35 (54,7) | 0,180 (NS) |
| ・ Emergency | 31 (55,4) | 25 (44,6) | |
| Type of anaesthesia | |||
| ・ General | 23 (50) | 23 (50) | 0,841 (NS) |
| ・ Local | 36 (50,7) | 35 (49,3) | |
| ・ Conversion | 1 (33,3) | 2 (66,7) | |
| Occlusive dressing N (%) | |||
|---|---|---|---|
| With | Without | P value | |
| Type of incision | |||
| ・ Transversal | 51 (51) | 49 (49) | 0,404 (NS) |
| ・ Median under umbilical | 9 (45) | 11 (55) | |
| Type of transversal incision | |||
| ・ Mouchel | 16 (47,1) | 18 (52,9) | 0,361 (NS) |
| ・ Pfannenstiel | 35 (53) | 31 (47) | |
| Blood transfusion | |||
| § Transfused | 8 (47,1) | 9 (52,9) | 0,500 (NS) |
| § None-transfused | 52 (50,5) | 51 (49,5) | |
| Cutaneous suture | |||
| ・ Intradermal overlock | 51 (50,5) | 50 (49,5) | 0,500 (NS) |
| ・ Separate points | 9 (47,4) | 10 (52,6) | |
| Nature of the thread | |||
| ・ Resorbable threads | 59 (50,9) | 57 (49,1) | 0,309 (NS) |
| ・ Non-resorbable threads | 1 (25) | 3 (75) | |
NS: non-significative.
Five patients with bandages feared the removal of the bandage because of the pain, a patient was afraid to see her wound in the group without dressing.
Postoperative follow-up was complicated without significant difference in operative site infection in both groups. One case of skin irritation was observed with the occlusive dressing (
When the dressing is not performed, the average cost of care is 5120 FCFA, while it is 3.5 times higher when the dressing is done, i.e. 18620 FCFA (
The average age of patients in our study is higher than that reported by Konan Wheat [
Like the African literature [
The qualification of the operator and the average duration of the operation did not influence the evolution of the postoperative course. The same observation was made by DossehEkoué [
Parietal infection of the operative site was observed without significant difference in both groups as in the Konan Wheat series [
| Occlusive dressing N (%) | |||
|---|---|---|---|
| With | Without | P value | |
| Operative suites | |||
| ・ Simples | 55 (49,5) | 56 (50,5) | 0,500 (NS) |
| ・ Complicated | 5 (55,6) | 4 (44,4) | |
| v Infection | 4 (57,1) | 3 (42,9) | 0,358 (NS) |
| v Disunity | 0 | 1 (100) | |
| v Irritation | 1 (100) | 0 | |
| Blood transfusion | |||
| ・ Transfused | 3 (50) | 3 (50) | 0,660 (NS) |
| ・ Non-transfused | 57 (50) | 57 (50) | |
| Group with bandage | Group without bandage | |||||
|---|---|---|---|---|---|---|
| Number | Price unitary | Total | Number | Price unitary | Total | |
| Povidone iodine dermal (125 ml) | 1 flacon | 1620 | 1620 | 1 flacon | 1620 | 1620 |
| Sterile compress (40 cm × 40 cm) | 4 boxes | 1500 | 6000 | 2 boxes | 1500 | 3000 |
| Plaster (18 cm × 10 cm) | 1 box | 7000 | 7000 | 0 | 0 | 0 |
| Surgical gloves 71/2 | 8 pairs | 500 | 4000 | 1 pair | 500 | 500 |
| Grand Total | 18,620 | 5120 | ||||
Similarly, in Switzerland, Meylan [
The incidence of surgical site infections is variable, and it is often difficult to compare two series because of the involvement of multiple factors [
Anyway, our different rates of infection of the operative site are significantly higher than those reported in developed countries ranging from 1.8 to 3.6% [
Cases of cutaneous irritation of the isolated skin were noted in the group with dressing.
The average duration of skin scarring is similar in both groups and is like that of Konan Ble [
Several authors [
The attitude of not covering the operative site with an occlusive dressing has advantages and does not have significant scientifically documented disadvantages.
Also, we note the reduction of the healing time, the costs related to the care, the workload of the nursing staff and the sharing of the management of the follow-up of the evolution of the said operation with the patient.
Therefore, dressing of the operative site is useless and should be totally removed.
Itoua, C., Lme, E., Mbongui, P.O.N., Koko, P.S. and Iloki, L.-H. (2018) Absence of Dressing versus Dressing in Gynaecological and Obstetrical Surgery at the University Hospital of Brazzaville. Open Journal of Obstetrics and Gynecology, 8, 246-252. https://doi.org/10.4236/ojog.2018.83026