comparative study of the efficacy and cost -effectiveness of occlusive versus conventional dressing in the treatment of open wounds and ulvers

The choice of wound dressing was limited until recently and dressing application, decided empirically and often left to the most junior member of the team. Many wound dressings are now available and others are under development. A study was carried out on 60 patients at Surgical Unit-I, Rawalpindi General Hospital, Rawalpindi from January 1996 to April 1997. Patients were divided into two groups and treated with pyodine gauze or hydrocolloid type of dressing. Twentythree [76.7 percent] were males and 7 [23.3 percent] were females in the pyodine gauze dressing group and 20 [66.7 percent] were males and 10 [33.3 percent] were female in the hydrocolloid dressing group. The major causes of the wounds in our study were road traffic accidents [50 percent hydrocolloid group, 60 percent Pyodine gauze group] incision and drainage of abscesses [23 percent hydrocolloid group, 27 percent pyodine gauze group] and post-operative appendicectomy wounds, intentionally left unstitched. Twentyfour patients [80 percent] in the pyodine gauze group and 25 patients [83.3 percent] in the hydrocolloid group completely healed and 3 patients in each group required secondary suturing. Skin grafting was done in 3[10 percent] patients in the pyodine gauze group and 2[6.7 percent] patients in the hydrocolloid group. Wound infection occurred in 4 patients [13.3 percent] in pyodine gauze group and one patient [3.3 percent] in hydrocolloid group. Incidence of positive growth with no clinical evidence of infection occurred in 6 patients [20 percent] in pyodine gauze group compared to one patient [3.3 percent] in hydrocolloid group. In the hydrocolloid group, 27 patients [90 percent] experienced marked reduction in pain compared with none in the pyodine group. Removal of dressing was easy in all the 30 [100 percent] patients in the hydrocolloid group compared with only 6 [20 percent] patients in the pyodine gauze group. Also removal of dressing was painless in all the patients in the hydrocolloid group, compared with painful dressing removal in 27 [90 percent] patients in the pyodine gauze group. Necrotic tissue in wound was softened in 24 [89 percent] patients in the hydrocolloid group compared with 2 [6.7 percent] patients in the pyodine gauze group. No exudate was found in wounds in 21 [70 percent] patients in the hydrocolloid group compared with 6 [20 percent] patients in the pyodine gauze group. The appearance of granulation tissue was good in 27 [90 percent] patients in the hydrocolloid group compared with 18 [60 percent] patients in the pyodine gauze group. The total number of dressings required to heal a wound completely ranged from 2 to 8 dressings for the hydrocolloid type [average 4.4 dressings], compared with the pyodine gauze requiring 7 to 29 dressings to heal a wound [average 16.1 dressings]. Total days to heal a wound under hydrocolloid dressing ranged from 14 to 49 days [average 26.7 days], compared with 11 to 74 days for pyodine gauze group [average 29.1 days]. Frequency of change of dressing was 4 to 7 days for hydrocolloid [average 6.14 days], compared with 1 to 3 days for pyodine gauze [average 1.84 days]