In the acute setting, most surgeons still favour the humble surgical gauze for initial wound dressing and packing. This is readily available at the time of operation, and most surgeons are familiar with it. However, it often becomes a hard adherent mass, making dressing changes a prolonged and painful ordeal for both the patient and the nurse. Indeed, alginates and foams are more cost-effective and kinder to the patient than simple surgical gauze when it comes to initial packing of surgical cavities. Negative pressure dressings may also have a role in dressing large cavities with copious amounts of exudates. These special dressings may have to be pre-ordered, as they may not be routinely available in the operating theatre. As for superficial wounds, low-adherence dressings can be used in conjunction with gauze to make dressing changes more comfortable.
In the chronic setting, surgical gauze has been superseded by the many modern alternatives discussed above. Hydrogels are useful in debriding sloughy wounds, while hydrofibres and foams are indicated where large amounts of exudates are expected. Although a Cochrane review in 2004 concluded that there was insufficient evidence to determine which dressing or topical agent affected healing rates of open surgical wounds, it found that foam was the best studied alternative to gauze. Foam appeared to be preferable in terms of pain reduction, patient satisfaction and nursing time. NICE guidelines state that alginates, foams, hydrocolloids and hydrogel dressings (as well as maggots) may reduce the pain from ‘difficult-to-heal’ surgical wounds.39
However, there was insufficient evidence to support one debriding agent over another.
Nowadays, there is a bewildering array of surgical dressings, and most hospitals have a tissue viability nurse to advise on the management of complex wounds. However, surgeons are still responsible for the initial wound dressing or packing. They should, therefore, become acquainted with the indications and limitations of the alternatives to the traditional surgical gauze.