Review for 10.1186/s12876-025-03922-y (2025)

Title: Effect of active wound dressing on postoperative pain and wound healing in patients
undergoing anorectal surgery
Version: 0 Date: 03 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The study design is retrospective, which inherently carries limitations, particularly about
selection bias. Although the groups were matched for baseline indices, it would be beneficial
to clarify how matching was performed. Were any specific covariates (e.g., age, comorbidities)
used to match the groups, and how were differences between the groups controlled for
statistically? Randomized controlled trials (RCTs) are considered the gold standard, and a
prospective RCT would provide stronger evidence of causality. Future studies should consider
a randomized design to reduce potential biases.
-Although the study mentions that the study group (SG) and control group (CG) were matched
for baseline indices, it lacks detail on how this matching process was carried out. Was this
matching done based on specific clinical characteristics such as age, comorbidities, or the
severity of the surgical condition? Providing additional details would help clarify whether any
potential confounders were accounted for. Furthermore, randomly allocating patients to the SG
and CG could have improved the study's rigor.
-Wound area reduction as the primary method for assessing healing is straightforward, but
a more nuanced approach could be considered. For example, the inclusion of qualitative
measures (e.g., wound appearance, presence of infection) or photography could complement the
quantitative data and provide more information on the overall healing process.
-The "granulation tissue formation time" is an important secondary outcome, but the method
of assessing granulation tissue could be better explained. Was this based on visual inspection,
scoring systems, or photographic evidence? A more standardized approach to this assessment
would strengthen the validity of the results.
-The discussion mentions that active wound dressings reduce pain, but the precise mechanisms
by which pain is alleviated could be expanded upon. While it is stated that these dressings create
a protective barrier and maintain a moist environment, more detail on the specific components
(e.g., silver ions or alginate) involved in pain modulation would strengthen this explanation. For
instance, how do the specific components of alginate dressing interact with the nerve endings
or reduce the pain perception at the surgical site?
-The discussion provides a strong explanation of how the antibacterial properties of active
wound dressings might contribute to reducing inflammation (e.g., by preventing bacterial
infections). However, the mechanisms by which growth factors (e.g., VEGF, EGF, bFGF) might
directly influence inflammation are less thoroughly explored. Future research could examine
how these growth factors, which promote tissue repair, might also play a role in regulating
the inflammatory response directly, perhaps by influencing the release of pro-inflammatory
cytokines or mediators.
-While the discussion provides a solid scientific explanation of how active wound dressings
work, it could benefit from a more explicit connection to clinical practice. For instance,
the practical implications of these findings in routine anorectal surgery recovery could be
emphasized more. How might this study change clinical guidelines or affect the day-to-day
management of postoperative patients? A more concrete discussion of how the findings could be
integrated into clinical settings would make the study more accessible to practicing healthcare
providers.