Post Operative Dressing After Clean Elective Hand Surgery

Itay Ashkenazi

Status: Completed

Conditions: Ganglion; Trigger Finger Disorder; Carpal Tunnel Syndrome

Treatments: Other: Dressing protocol

Study type: Interventional

Funder types: Other

Identifiers

NCT04268095

0548-18-TLV

Details and patient eligibility

About

Very little has been published about the optimal post operative dressing protocol, and no practical conclusion has emerged from a meta-analysis published in 2013. Even fewer studies focused on that topic specifically in hand surgery. Nevertheless, the functional impairment due to a dressing in the hand is much greater than anywhere else, due to the constant use of hands in daily life activities. Yet, habits differs widely following surgeon's preference, from daily change with application of an antimicrobial unguent, to unchanged dressing until the first follow up consultation after 2 weeks, to complete removal of the dressing and basic soap and water cleaning at postoperative day (POD) 1. Those varying recommendations have functional and logistical implication for the patients, especially the elderlies, for whom autonomy is a fragile status that can be dramatically impaired by such protocols. The goal of this study is to define which post operative dressing protocol is optimal in terms of wound complications (disunion, infection)

Enrollment: 60 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

* Elective hand surgery with clean wound (Type 1 in wound classification of american college of surgeon 11) - (Carpal tunnel, trigger finger, cyst removal or foreign body removal, tendon release).

Exclusion criteria

• Insertion of hardware
• Known skin condition disturbing normal healing,
• Immunodeficiency,
• Incapacity to understand or to observe the self cleaning protocol.
• Unexpected peroperative complication leading to a modification of the operative technique.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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60 participants in 3 patient groups

No dressing change

Experimental group

Description:

Patients do not change dressing from procedure to first clinic followup after 14 days.

Treatment:

Other: Dressing protocol

Ambulatory dressing change

Experimental group

Description:

Patients change dressing by an ambulatory nurse (not associated with the study) 2 times a week from surgery to first clinic followup after 14 days

Treatment:

Other: Dressing protocol

No dressing

Experimental group

Description:

Patients take off dressing at post operative day 1 and clean it 3 times per day as instructed.

Treatment:

Other: Dressing protocol