Dressing Wear Time after Breast Reconstruction: A Randomized Clinical Trial

<div><p>Background</p><p>The evidence to support dressing standards for breast surgery wounds is empiric and scarce.</p><p>Objective</p><p>This two-arm randomized clinical trial was designed to assess the effect of dressing wear time on surgical site infection (SSI) rates, skin colonization and patient perceptions.</p><p>Methods</p><p>A total of 200 breast cancer patients undergoing breast reconstruction were prospectively enrolled. Patients were randomly allocated to group I (dressing removed on the first postoperative day, n = 100) or group II (dressing removed on the sixth postoperative day, n = 100). SSIs were defined and classified according to criteria from the Centers for Disease Control and Prevention. Samples collected before placing the dressing and after 1 day (group I) and 6 days (both groups) were cultured for skin colonization assessments. Patients preferences and perceptions with regard to safety, comfort and convenience were recorded and analyzed.</p><p>Results</p><p>A total of 186 patients completed the follow-up. The global SSI rate was 4.5%. Six patients in group I and three in group II had SSI (p = 0.497). Before dressing, the groups were similar with regard to skin colonization. At the sixth day, there was a higher colonization by coagulase-negative staphylococci in group I (p<0.0001). Patients preferred to keep dressing for six days (p<0.0001), and considered this a safer choice (p<0.05).</p><p>Conclusions</p><p>Despite group I had a higher skin colonization by coagulase-negative staphylococci on the sixth postoperative day, there was no difference in SSI rates. Patients preferred keeping dressing for six days and considered it a safer choice.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT01148823" target="_blank">NCT01148823</a></p></div

CONSORT Flow Diagram [43]

<p>CONSORT Flow Diagram [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0166356#pone.0166356.ref043" target="_blank">43</a>]</p

Microorganisms growth in thioglycolate broth and glucose broth and comparison between group I and group II by Chi-square test

<p>Microorganisms growth in thioglycolate broth and glucose broth and comparison between group I and group II by Chi-square test</p

Perceptions of patients in group I (n = 82) and group II (n = 81) related to their dressing wear time

<p>Perceptions of patients in group I (n = 82) and group II (n = 81) related to their dressing wear time</p

Time and technique of breast reconstruction and comparison between group I and group II by Chi-square test

<p>Time and technique of breast reconstruction and comparison between group I and group II by Chi-square test</p

Demographic and surgical variables of patients in both groups and comparison by Mann-Whitney U test

<p>Demographic and surgical variables of patients in both groups and comparison by Mann-Whitney U test</p

Patients’ preferences for dressing wear time and comparison between groups I and II by Chi-square test

<p>Patients’ preferences for dressing wear time and comparison between groups I and II by Chi-square test</p

Association between technique of breast reconstruction and SSI occurrence, in groups I and II and overall, by Chi-square test

<p>Association between technique of breast reconstruction and SSI occurrence, in groups I and II and overall, by Chi-square test</p

Skin colonization results

<p>Skin colonization results</p