What is the treatment for superficial surgical site infection using wet-to-dry (wet-to-dry) dressings?

From the Guidelines

The most effective treatment for superficial surgical infections is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention, with wet-to-dry dressings being a second-line option. According to the 2018 WSES/SIS-E consensus conference recommendations 1, incisional SSIs should always be drained, irrigated, and if needed, opened and debrided. The use of wet-to-dry dressings is still a viable option, but it is now considered a second-line treatment due to its potential to cause pain, remove healthy tissue, and require frequent changes.

Some key points to consider when treating superficial surgical infections include:

• The importance of addressing the underlying infection with appropriate antibiotics, as recommended by the Infectious Diseases Society of America 1
• Ensuring adequate nutrition and controlling comorbidities like diabetes, as these factors can impact wound healing
• The use of modern alternatives to wet-to-dry dressings, such as moisture-retentive dressings, negative pressure wound therapy, and enzymatic debridement products
• The need to create an environment that supports tissue healing while removing infectious material, as emphasized by the 2018 WSES/SIS-E consensus conference recommendations 1

In terms of specific treatment protocols, the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1 suggest that antibiotics are unnecessary if there is less than 5 cm of erythema and induration, and if the patient has minimal systemic signs of infection. However, patients with temperature greater than 38.5°C or heart rate greater than 110 beats/minute or erythema extending beyond the wound margins for more than 5 cm may require a short course of antibiotics, as well as opening of the suture line.

Overall, the goal of treatment for superficial surgical infections is to promote wound healing, prevent further complications, and improve patient outcomes, with the most recent and highest quality evidence guiding treatment decisions 1.

From the Research

Treatment of Superficial Surgical Infection

• The treatment of superficial surgical infections, including the use of wet to dry dressings, is a complex topic with various approaches and considerations 2, 3, 4, 5, 6.
• According to the study by 3, there is no clear evidence to suggest that any dressing significantly reduces the risk of developing a surgical site infection (SSI) compared to leaving wounds exposed or compared to alternative dressings.
• The study by 4 also found that there is insufficient evidence to determine whether covering surgical wounds healing by primary intention with wound dressings reduces the risk of SSI or whether any particular wound dressing is more effective than others.
• However, the study by 5 suggests that the management of SSI includes consistent antibiotic therapy, wound drainage, and rigorous wound debridement as appropriate, and that specific wound management thereafter depends on the location and nature of infection.
• The guidelines updated by the Surgical Infection Society in 2021 6 provide recommendations for the treatment of complicated skin and soft tissue infections, including the use of antimicrobial therapy and operative interventions.

Wound Dressings

• The use of wound dressings, including wet to dry dressings, is a common practice in the treatment of superficial surgical infections 2, 3, 4.
• However, the evidence suggests that there is no clear benefit to using any particular type of dressing over another in preventing SSI 3, 4.
• The study by 2 highlights the importance of aligning the use of antimicrobial wound dressings with antimicrobial stewardship programs and investigating alternatives to active antimicrobials.

Antimicrobial Therapy

• The use of antimicrobial therapy is a crucial aspect of the treatment of superficial surgical infections 5, 6.
• The study by 5 suggests that new antibiotics, such as avibactam and dalbavancin, may be alternatives to existing treatments, but should only be used on the basis of susceptibility testing and if standard drugs are inappropriate.
• The guidelines updated by the Surgical Infection Society in 2021 6 provide recommendations for the use of antimicrobial therapy in the treatment of complicated skin and soft tissue infections.