Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
BJOG. 2020 Sep;127(10):1250-1258. doi: 10.1111/1471-0528.16228. Epub 2020 Apr 16.
To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure.
Randomised trial.
University Hospital, Malaysia: April 2016-October 2016.
331 women delivered by caesarean section.
Participants were randomised to leaving their wound entirely exposed (n = 165) or dressed (n = 166) with a low adhesive dressing (next day removal).
Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge.
The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk [RR] 0.4, 95% CI 0.1-2.1; P = 0.45) and patient satisfaction with wound management was 7 [5-8] versus 7 [5-8] (P = 0.81) in exposed compared with dressed study groups, respectively. In the wound-exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound-dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre-randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post-hospital discharge self-reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups.
The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken.
An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance.
评估与皮肤缝合后覆盖相比，在对横切口耻骨上方剖宫产术的伤口进行暴露处理时，在术后 28 天内伤口浅表性手术部位感染（SSI）发生率和患者对伤口覆盖管理的满意度。
随机试验。
马来西亚大学医院，2016 年 4 月至 2016 年 10 月。
331 例剖宫产产妇。
将参与者随机分为完全暴露伤口组（n=165）或覆盖伤口组（n=166），用低粘性敷料覆盖（次日去除）。
主要结局是评估者通过检查评估（直至出院和出院后 14 天和 28 天进行电话询问）确定的浅表性 SSI 发生率，以及患者在出院前对伤口覆盖管理的满意度。
暴露组的 SSI 发生率为 2/153（1.3%），而覆盖组为 5/157（3.2%）（相对风险[RR]0.4，95%CI0.1-2.1；P=0.45），暴露组和覆盖组患者对伤口管理的满意度分别为 7[5-8]和 7[5-8]（P=0.81）。在暴露伤口的患者中，对伤口暴露的意愿明显从 35.5%增加到 57.5%，而在覆盖伤口的患者中，在招募时（随机分组前）和 28 天时，对覆盖伤口的意愿从 48.5%下降到 34.4%。整个试验过程中，各组患者在住院期间伤口护理的额外敷料或纱布使用、出院后自我报告的伤口感染、抗生素、红肿和炎症、肿胀、疼痛和液体漏出等方面无明显差异。
由于 SSI 发生率低于预期，因此该试验的效能不足。然而，暴露剖宫产伤口似乎不会产生不良影响，只要对患者进行管理预期的咨询。
与覆盖伤口相比，暴露处理的剖宫产伤口具有相似的浅表性手术部位感染率、患者满意度和外观。
