New dressing system could reduce number of dressings in enhanced-recovery THA

To improve postoperative rehabilitation and reduce postoperative complications, the concept of enhanced recovery after surgery (ERAS) has gained attention in joint arthroplasty surgery. Wound management is an important part of the perioperative period.

Currently, there is a paucity of recommendations in regards to dressing selection within the ERAS protocol. Pengfei Lei et al devised a new dressing system to accelerate the recovery after total hip arthroplasty (THA).

The authors prospectively enrolled 124 patients who underwent a primary THA. The patients were randomly assigned to the intervention (the new dressing system group) or the control (the traditional gauze dressing) group. After suturing the surgical incision, place the calcium alginate dressing (Algisite M, Smith & Nephew, London, United Kingdom) folded into three layers on the incision; choose 3 or 4 pieces of the semi-occlusive, transparent adhesive film (IV3000, Smith & Nephew) as per the length of the incision to paste and fix. There were no air bubbles between the films and the skin, thus they adhered to the skin. In the control group, after suturing of the surgical incision, the wound was covered with eight layers of aseptic gauze, then one layer of aseptic cotton pad, and finally secured with plastic tape along the long axis of the wound.

All patients should have their dressings changed when the dressing has been soaked through, the dressing has become loose or fallen off, or the patient felt uncomfortable. Patients using the new dressing system were allowed to bath as usual based on their lifestyle except for sub merging wounds and dressings in the water. Patients who had traditional gauze dressing can only brush their bodies 2 weeks following the operation and they are not allowed to take showers or bubble baths to avoid wetting the dressings. All patients' dressings were removed 2 weeks after operation and wounds were evaluated.

The primary outcome measures of this study were numbers of dressing changes, postoperative lengths of stay, wound scores including the Stony Brook Scar Evaluation Scale and ASEPSIS scores and wound-related complications. The secondary outcomes include satisfaction scores, dressing-related costs, and pain and functional recovery scores.

The key findings of the study are:

• The intervention group numbers of dressing changes and postoperative lengths of stay were significantly less than the control group (P < .001, P < .001).

• During the one-month follow-up, the Stony Brook Scar Evaluation Scale in the intervention group was significantly better than that in the control group (P < .001).

• The intervention group satisfaction was significantly higher than that in the control group (P < .001).

• There were no statistically significant differences between the two groups in terms of dressing-related costs and pain and function scores.

The authors concluded that –

“The new dressing system could reduce the number of dressing changes and postoperative lengths of stay and increase patient satisfaction, which can be an ideal adjunct to wound management in enhanced-recovery THA.”

Further reading:

A New Dressing System for Wound in Enhanced-Recovery Total Hip Arthroplasty: A Randomized and Controlled Trial

Pengfei Lei, Da Zhong et al

The Journal of Arthroplasty

https://doi.org/10.1016/j.arth.2023.02.029