What is the preferred dressing, gauze or Tegaderm, for post-operative incision sites in class 2-3 wounds to prevent Surgical Site Infections (SSI)?

Wound Dressing Selection for Class 2-3 Surgical Wounds

For class 2-3 (contaminated/dirty-infected) post-operative wounds, neither gauze nor Tegaderm should be used as primary wound management—instead, vacuum-assisted closure (negative pressure wound therapy) is strongly recommended, as it reduces SSI rates from 37% with primary closure to 0% in contaminated wounds. 1

Primary Recommendation: Vacuum-Assisted Closure for High-Risk Wounds

For class 2-3 wounds specifically, the evidence strongly favors negative pressure wound therapy over any standard dressing approach:

• Vacuum-assisted closure demonstrated 0% SSI rate in contaminated/dirty-infected laparotomy wounds, compared to 37% with primary closure using standard dressings and 17% with delayed primary closure 1
• This represents a statistically significant reduction in infection rates compared to both gauze-based and film-based dressing approaches 1
• Closed-incision negative pressure therapy (cINPT) combined with delayed closure is specifically effective for preventing SSI in contaminated wounds 1

If Standard Dressings Must Be Used

When vacuum-assisted closure is not available or feasible, the guideline evidence indicates:

• No advanced dressing (including Tegaderm) should be used over standard dressings for primarily closed surgical wounds, as there is no evidence they reduce SSI rates 1
• The WHO Global Guidelines explicitly recommend against using advanced dressings over standard dressings for SSI prevention, based on low-quality evidence from ten RCTs showing no significant SSI reduction 1
• A 2016 Cochrane review concluded it is uncertain whether any particular wound dressing is more effective than others in reducing SSI risk 1

Standard Dressing Management Protocol

If using conventional dressings for class 2-3 wounds:

• Keep the surgical wound dressing undisturbed for a minimum of 48 hours after surgery unless leakage occurs 1
• There is no evidence that extending dressing time beyond 48 hours reduces SSIs 1
• Base dressing selection decisions on cost and patient preference rather than SSI prevention efficacy 1

Critical Caveat for Class 2-3 Wounds

The guideline evidence primarily addresses primarily closed surgical wounds, while class 2-3 wounds often require different closure strategies:

• For contaminated/dirty-infected wounds, primary closure with standard dressings carries a 37% SSI rate 1
• Consider delayed primary closure (17% SSI rate) if vacuum-assisted closure is unavailable 1
• The small study size (n=81 total, n=25 in VAC group) should be noted, but the dramatic difference (0% vs 37% SSI) is clinically compelling 1

Cost-Effectiveness Considerations

• Multiple studies demonstrate that cINPT is cost-saving in high-risk patients despite higher upfront costs 1
• Cost-effective alternatives using standard gauze sealed with occlusive dressing and wall suction appear similarly effective to commercial cINPT systems 1
• For standard dressings, cost should guide selection since efficacy differences are not established 1

Bottom Line Algorithm

For class 2-3 wounds:

1. First choice: Vacuum-assisted closure (0% SSI rate) 1
2. Second choice: Delayed primary closure with standard dressing (17% SSI rate) 1
3. Avoid: Primary closure with either gauze or Tegaderm (37% SSI rate) 1
4. If standard dressing required: Use gauze or Tegaderm based on cost/preference—no efficacy difference established 1