Impact of Timing of Wound Dressing Removal After Cesarean Section
Condition: Abdominal Wall Wound
MeSH terms: Wounds and Injuries
Study type: Interventional

Summary: 
      The purpose of this study is to assess wound healing at 24 vs 48 hours post cesarean delivery
      with a modified 1-day ASEPSIS score.
    

Detailed description: 
      Immediate wound coverage is one of the cornerstones of post-operative wound management.
      Dressings are typically left in place for 24 to 48 hours following cesarean section to allow
      ample time for healing and re-epithelialization. The functions of a surgical dressing for
      wound healing by primary intention are to control postoperative bleeding, absorb exudate,
      ease pain, and provide protection for newly-formed epithelium. The skin is an important
      anatomical barrier against microbes; the reformation of an intact epithelial system following
      injury is an important milestone for the prevention of infection.

      Wound healing is a dynamic process that involves the coordinated interaction of a variety of
      cells, including cytokines, blood cells, extracellular matrix proteins, and parenchyma cells.
      Wound healing has been artificially divided into three phases: inflammation, tissue formation
      (proliferation), and tissue remodeling. These phases do not correspond to a precise period of
      time following injury, and all of the phases overlap to some degree. Re-epithelialization
      occurs during the proliferation phase and it is defined as the process of restoring an intact
      epidermis after injury. It involves several processes, including the migration and
      proliferation of adjacent epidermal keratinocytes into the wound, the differentiation of the
      neo-epithelium into a stratified epidermis, and the restoration of an intact basement
      membrane zone (BMZ) that will connect the epidermis and the underlying dermis.
      Re-epithelialization of wounds begins within hours after injury. Within 24 hours,
      keratinocytes are actively proliferating from the margins of the wound to cover the defect.

      Surgical wounds that are closed by primary intention usually heal rapidly, and
      re-epithelialization is thought to occur within 24 to 48 hours. Early studies into wound care
      demonstrated that dressings influence the repair process. The postoperative wound dressing
      acts to ensure the wound bed stays moist, decrease pain and inflammation, and improve scar
      appearance. Additionally, occlusive dressings increase the rate of re-epithelialization
      post-operatively compared to those wounds left open. The importance of dressings has been
      established, but the ideal time that postoperative dressings should remain in place remains
      elusive. Studies have shown that early removal of dressings (6 hours after wounding) markedly
      decreases the rate of resurfacing while leaving the bandage on for greater than 48 hours
      produced no greater benefit. The United States Centers for Disease Control and Prevention
      recommends that the sterile dressing stays in place for 24-48 hours postoperatively on an
      incision that has been closed by primary intention. Although the window of the benefit
      provided by bandages has not been further refined since these earlier studies. By defining
      the period during which dressings will promote epithelial resurfacing, our ability to use the
      dressing optimally will be enhanced.

      Our goal of this study is to compared the impact of dressing removal at 24 vs 48 hours on
      wounds following low-risk cesarean deliveries. While epithelial proliferation begins within
      hours of closure, it is not at its maximum until 48 to 72 hours following injury. The current
      standard of care is to keep the dressing in place 24 to 48 hours postoperatively. However,
      there is no data comparing the optimum timing between 24 and 48 hours. We will, therefore,
      assess the benefit of leaving the dressing in place for 24 vs 48 hours postoperatively by
      evaluating its impact on wound appearance and wound score using the ASEPSIS scoring method.

      The ASEPSIS is a quantitative scoring method that provides a numerical score related to the
      severity of wound infection using objective criteria based on wound appearance and the
      clinical consequences of the infection in 5 days postoperatively. The severity of impaired
      wound healing is indicated by the total score as follows: satisfactory healing 0 to 10;
      disturbance of healing 11 to 20; minor wound infection 21 to 30; moderate wound infection 31
      to 40; and severe wound infection more than 40. For practical reasons, absolute scores were
      obtained based on a 1-day reading in our study, rather than the 5-day reading used in the
      original ASEPSIS scoring system. Another objective of this study is to evaluate patients'
      satisfaction according to complaints about their incision. Pain, erythema, induration,
      separation of skin, and serous or purulent exudates will be documented.
    

Intervention name(s): Dressing removal at 24 hours; Dressing removal at 48 hours
Intervention type(s): Other; Other
Intervention description(s): Dressing will be removed 24 hours after cesarean section and wounds will be assessed for healing and presence of infection.; Dressing will be removed 48 hours after cesarean section and wounds will be assessed for healing and presence of infection.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Cesarean Section; Wound Healing