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 explain. These 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 told Reuters Health 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 U.S., two in Italy, and the rest in other European countries, Asia or Africa. Four compared antiseptic treatment to 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 may 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 September 28 JAMA Dermatology summary of the Cochrane review.
But the reviewed studies were small and often poorly reported, and the interventions they examined may not accurately reflect current clinical practice, the authors note.
"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.
Since 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/or 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.
"It is important to note that, whilst further randomized controlled trials in the field are required, they should be of high quality using methodology that minimizes bias," Norman said.
JAMA Dermatol 2016.