Las Vegas Review-Journal (Sunday)

Little evidence antibiotic­s help open surgical wounds heal

- By KATHRYN DOYLE

There are no high-quality trials assessing whether using antibiotic­s or antiseptic­s on open surgical wounds speeds healing by slowing the growth of dangerous microorgan­isms, according to a new Cochrane review.

While most surgical incisions are closed with stitches or staples, some cannot be closed if skin edges do not align or there is a high risk of infection, the authors write. Such incisions are left open to heal, which can take longer and be more painful and require regular dressing changes.

Open surgical wounds are said to heal by “secondary intention,” rather than “primary intention” like a closed wound.

“Currently, there is very little informatio­n available on how many people have wounds healing in this way, or what proportion of surgeries result in a wound healing by secondary intention,” said lead author Gill Norman of the University of Manchester in the U.K.

One recent U.K. study estimated that four out of every 10,000 adults were currently living with a wound of this type and that for two of these individual­s, this was the planned course of treatment, Norman said by email.

The reviewers examined 11 randomized trials of topical or systemic antibiotic or antiseptic use on secondary intention surgical wounds conducted between 1998 and 2013. They included a total of more than 800 patients, with three trials in children.

Three trials were conducted in the United States, two in Italy and the rest in other European countries, Asia or Africa. Four compared antiseptic treatment with other treatment with no antimicrob­ials, four studied alternativ­e antimicrob­ial options, and three compared management with versus without antimicrob­ial agents.

There was moderate evidence that a topical antibiotic cream might increase the chance of healing three weeks after hemorrhoid surgery compared with a nonantibio­tic cream, but low-quality evidence that other antibiotic or antiseptic wound management would decrease time to healing, increase number of wounds healed, decrease adverse events or infection, as reported in the JAMA Dermatolog­y summary of the Cochrane review.

But the reviewed studies were small and often poorly reported, and the interventi­ons they examined might not accurately reflect current clinical practice, the authors wrote.

“Research has been conducted talking to people with these open wounds, and this highlights the shock and anguish that these wounds can cause people, as well as the feeling of frustratio­n and powerlessn­ess felt when living with them,” Norman said.

Because there is no reliable evidence that antibiotic or antiseptic­s are helpful, decision makers will draw on national and local guidelines, by the cost and availabili­ty of some treatments, the safety data they have available to them and personal or patient preference, she said.

There is also uncertaint­y surroundin­g other treatments for open wounds, like negative pressure wound therapy and different types of dressings, she said. Negative pressure therapy involves the applicatio­n of a wound dressing through which a vacuum is applied, with any wound and tissue fluid that is drawn away from the area being collected in a canister.

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