Post Operative Dressing After Clean Elective Hand Surgery

Study Overview
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Brief Summary
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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)

Official Title
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Post Operative Dressing After Clean Elective Hand Surgery

Conditions
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Trigger Finger Disorder, Carpal Tunnel Syndrome, Ganglion

Intervention / Treatment
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* Other: Dressing protocol


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: No dressing change<br>Patients do not change dressing from procedure to first clinic followup after 14 days. | Other: Dressing protocol<br>* Patients are assigned with different postoperative dressing protocols.<br>|
| Experimental: Ambulatory dressing change<br>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 | Other: Dressing protocol<br>* Patients are assigned with different postoperative dressing protocols.<br>|
| Experimental: No dressing<br>Patients take off dressing at post operative day 1 and clean it 3 times per day as instructed. | Other: Dressing protocol<br>* Patients are assigned with different postoperative dressing protocols.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Instrumental activities of daily living questioner (IADL) | Subjective function questioner. Scale 0-18. Higher score - better outcome. | Baseline (Pre-op), 2 weeks, 6 weeks, 3 months | 
| Change in Vancouver Scar Scale | Evaluation of skin healing and scar formation. Scale 0-14. Higher score - inferior outcome. | 2 weeks, 6 weeks, 3 months | 
| Change in quick Disability of the Arm, Shoulder and Hand questioner (DASH) | Subjective function questioner. Scale 0-100. Higher score - inferior outcome. | Baseline, 2 weeks, 6 weeks, 3 months |