The Effect of Postoperative Dressing Change Frequency on Wound Healing and Complications in Patients Undergoing Carpal Tunnel Release: A Randomized Clinical Trial

Document Type : RESEARCH PAPER

Authors

1 Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Acute Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, United Kingdom

10.22038/abjs.2024.78146.3620

Abstract

Objectives: Post-operative wound complications are relatively common. The development of an optimal protocol for the frequency of wound dressing change that results in minimal complications seems crucial. The current study aims to compare two different protocols of single and intermittent dressing change for patients undergoing carpal tunnel release (CTR) in terms of: 1) wound healing indicators and 2) complications.
Methods: In this two-arm parallel randomized clinical trial study, 60 patients who were planned to undergo CTR were enrolled. The participants were randomly assigned to two groups: group A) receiving a single dressing, and group B) receiving intermittent dressing changes every other day. After two weeks, all patients were evaluated for epithelialization, exudate amount, localized pain, localized erythema, localized edema, delayed healing, necrosis, fibrosis, final overall wound condition, final skin condition as indicators of wound healing, and signs of infection. We also employed the Visual Analogue Scale (VAS) to evaluate the pain intensity.
Results: There was no difference between the two groups in terms of basic demographic variables. The results revealed no significant difference in any of the measured wound healing indicators and complications except for the epithelialization rate which was higher in the single-dressing group (8 patients in the single group vs. 0 in the intermittent group; P-value < 0.001).
Conclusion: Overall, the findings suggest that use of the intermittent dressing change protocol for CTR surgery wounds does not improve wound healing or mitigate complications, in comparison to the single dressing protocol, which is more cost-beneficial.
        Level of evidence: II

Keywords

Main Subjects

References

  1. Glennie RA, Dea N, Street JT. Dressings and drains in posterior spine surgery and their effect on wound complications. J Clin Neurosci. 2015; 22(7):1081-1087. doi: 10.1016/j.jocn.2015.01.009.
  2. Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of wounds and evaluation of healing. Wound Repair Regen. 1994; 2(3):165-170. doi: 10.1046/j.1524-475X.1994.20305.x.
  3. Lumbers M. Selecting appropriate postoperative dressings to support wound healing and reduce surgical site infection. Br J Nurs. 2018; 27(6):S32-S35. doi: 10.12968/bjon.2018.27.6.S32.
  4. Givissis P, Stavridis SI, Ditsios K, Christodoulou A. One-stage thumb lengthening with use of an osteocutaneous 2nd metacarpal flap. Strategies Trauma Limb Reconstr. 2009; 4(3):135-9. doi:10.1007/s11751-009-0074-z.
  5. Arroyo AA, Casanova PL, Soriano JV, Torra I Bou JE. Open‐label clinical trial comparing the clinical and economic effectiveness of using a polyurethane film surgical dressing with gauze surgical dressings in the care of post‐operative surgical wounds. Int Wound J. 2015; 12(3):285-292. doi:10.1111/iwj.12099.
  6. Eberhardt D, Berg A, Fleischer S, Langer GJP. Timing of dressing removal in the healing of surgical wounds by primary intention: a meta-analysis. Pflege. 2013; 26(4):255-269. doi:10.1024/1012-5302/a000304.
  7. Bains RS, Kardile M, Mitsunaga LK, Bains S, Singh N, Idler C. Postoperative spine dressing changes are unnecessary. Spine Deform. 2017; 5:396-400. doi: 10.1016/j.jspd.2017.04.005.
  8. Mendes DA, Veiga DF, Veiga-Filho J, et al. Influence of dressing application time after breast augmentation on cutaneous colonization: A randomized clinical trial. J Plast Reconstr Aesthet Surg. 2018; 71(6):906-912. doi: 10.1016/j.bjps.2018.01.021.
  9. Veiga DF, Damasceno CAV, Veiga-Filho J, et al. Dressing wear time after breast reconstruction: a randomized clinical trial. PLoS One. 2016; 11(12):e0166356. doi: 10.1371/journal.pone.0166356.
  10. Veiga-Filho J, Veiga DF, Sabino-Neto M, et al. Dressing wear time after reduction mammaplasty: a randomized controlled trial. Plast Reconstr Surg. 2012; 129(1):1e-7e. doi: 10.1097/PRS.0b013e3182361ee9.
  11. Chrintz H, Vibits H, Cordtz TO, Harreby JS, Waaddegaard P, Larsen SO. Need for surgical wound dressing. Br J Surg. 1989; 76(2):204-205. doi: 10.1002/bjs.1800760232.
  12. Borkar N, Khubalkar MV. Are postoperative dressings

 

        necessary? J Wound Care. 2011; 20(6):301-303. doi: 10.12968/jowc.2011.20.6.301.

  1. Merei JM. Pediatric clean surgical wounds: is dressing necessary? J Pediatr Surg. 2004; 39(12):1871-1873. doi: 10.1016/j.jpedsurg.2004.08.017.
  2. Ritting AW, Leger R, O'Malley MP, Mogielnicki H, Tucker R, Rodner CM. Duration of postoperative dressing after mini-open carpal tunnel release: a prospective, randomized trial. J Hand Surg Am. 2012; 37(1):3-8. doi: 10.1016/j.jhsa.2011.10.011.
  3. Williams AM, Baker PA, Platt AJ. The impact of dressings on recovery from carpal tunnel decompression. J Plast Reconstr Aesthet Surg. 2008; 61(12):1493-1495. doi: 10.1016/j.bjps.2007.10.006.
  4. Atlan F, Ashkenazi I, Shehadeh K, et al. Early postoperative dressing removal in hand surgery: Novel concepts for individualized surgical dressing management. Hand Surg Rehabil. 2021; 40(4):389-393. doi: 10.1016/j.hansur.2021.03.011.
  5. Toon CD, Sinha S, Davidson BR, Gurusamy KS. Early versus delayed post‐operative bathing or showering to prevent wound complications. Cochrane Database Syst Rev. 2015 ;(7). doi: 10.1002/14651858.CD010075.pub3.
  6. Dumville JC, Gray TA, Walter CJ, et al. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev. 2016 ;( 12). doi: 10.1002/14651858.CD003091.pub4.
  7. Berg L, Martinez JL, Serena TE, Dhoonmoon L, Ousey K. Meeting report: promoting wound healing by optimising dressing change frequency. Wounds International. 2019; 10(3):44-51.
  8. Dale AM, Harris-Adamson C, Rempel D, et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health. 2013; 39(5):495. doi: 10.5271/sjweh.3351.
  9. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999; 282(2):153-158. doi: 10.1001/jama.282.2.153.
  10. Hassankhani GG, Moradi A, Birjandinejad A, Vahedi E, Kachooei AR, Ebrahimzadeh MH. Translation and validation of the Persian version the Boston carpal tunnel syndrome questionnaire. Arch Bone Jt Surg. 2018; 6(1):71.
  11. Van Suchtelen M, Becker SJ, Gruber JS, Ring D. Progression of carpal tunnel syndrome according to electrodiagnostic testing in nonoperatively treated patients. Arch Bone Jt Surg. 2014; 2(3):185.
  12. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310(20):2191-4. doi: 10.1001/jama.2013.281053.
  13. Bates-Jensen BM, Vredevoe DL, Brecht ML. Validity and reliability of the pressure sore status tool. Decubitus 1992; 5(6):20-28.
  14. Crichton N. Visual analogue scale (VAS). J Clin Nurs. 2001; 10(5):706-6.
  15. De Leon JM, Barnes S, Nagel M, Fudge M, Lucius A, Garcia B. Cost-effectiveness of negative pressure wound therapy for postsurgical patients in long-term acute care. Adv Skin Wound Care. 2009; 22(3):122-127. doi: 10.1097/01.ASW.0000305452.79434.d9.
  16. Bates-Jensen B. Bates-Jensen wound assessment tool. Agency for clinical innovation. Available at: https://aci.health.nsw.gov.au/__data/assets/pdf_file/0010/388243/22.-Bates-Jensen-wound-assessment-tool-BWAT.pdf. Accessed September 12, 2023.
  17. Hjermstad MJ, Fayers PM, Haugen DF, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011; 41(6):1073-1093. doi: 10.1016/j.jpainsymman.2010.08.016.
  18. Haefeli M, Elfering A. Pain assessment. Eur Spine J Jan. 2006; 15 Suppl 1(Suppl 1):S17-24. doi:10.1007/s00586-005-1044-x.
  19. Gallucci GL, Rosa YC, Cerrutti WG, Tanoira I, Rellán I. WALANT technique versus local anesthesia with a tourniquet in carpal tunnel syndrome. Archives of Bone and Joint Surgery. 2023;11(5):321.
  20. Abdoli Tafti A, Farhadirad H, Farhadirad M, Saeed-Banadaky SH, Gholizadeh M, Farhadirad P. Drain Use in Bilateral Carpal Tunnel Release: A Randomized Clinical Trial on Efficacy and Patient Satisfaction. The Archives of Bone and Joint Surgery. 2025 Oct 19.
  21. Kim YH, Hwang KT, Kim JT, Kim SW. What is the ideal interval between dressing changes during negative pressure wound therapy for open traumatic fractures? J Wound Care. 2015; 24(11):536-542. doi: 10.12968/jowc.2015.24.11.536.
  22. Baxter H. Management of surgical wounds. Nurs Times. 2003; 99(13):66-8.
  23. Singh S, Young A, McNaught CE. The physiology of wound healing. Surgery (Oxf). 2017; 35(9):473-477. doi: 10.1016/j.mpsur.2017.06.004.
  24. Vowden K, Vowden P. Understanding exudate management and the role of exudate in the healing process. Br J Community Nurs. 2003; 8(Sup5):S4-S13. doi: 10.12968/bjcn.2003.8.sup5.12607.
  25. Sundell B, Symposium on Wound Healing ym. The effect of temperature on mitotic activity at the edge of experimental wounds. In: Symposium on Wound Healing - Plastic Surgical and Dermatological Aspects; Espoo 1979. 1st ed. PM L, eds. Molndal; 1980.
  26. Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962; 193(4812):293-294. doi: 10.1038/193293a0.
  27. Eaglstein WH, Davis SC, Mehle AL, Mertz PM. Optimal use of an occlusive dressing to enhance healing: Effect of delayed application and early removal on wound healing. Arch Dermatol.1988; 124(3):392-395.
  28. Woodley DT, Kim YH. A double-blind comparison of adhesive bandages with the use of uniform suction blister wounds. Arch Dermatol.1992; 128(10):1354-1357.
  29. Dosseh Eacute Koué D, Doleaglenou A, Fortey YK, Ayite AE. Randomized trial comparing dressing to no dressing of surgical wounds in a tropical setting. J Chir (Paris). 2008; 145(2):143-146.
  30. Cook AC, Szabo RM, Birkholz SW, King EF. Early mobilization following carpal tunnel release: a prospective randomized study. J Hand Surg Br. 1995; 20(2):228-230. doi: 10.1016/s0266-7681(05)80057-9.

 

The Archives of Bone and Joint Surgery
Volume 13, Issue 12
December 2025
Pages 816-822

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History

  • Receive Date: 09 April 2024
  • Revise Date: 14 March 2025
  • Accept Date: 05 October 2024

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