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No difference in wound complications with or without a post-operative pressure dressing: Our experience in 135
Shadi Shinnawi1,2, Arie Gordin1, Iyad Zaroura1
1Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel.
Insights
Avoiding mastoid pressure dressing (MPD) after pediatric mastoidectomy does not reduce wound complications but does decrease post-operative pain. This study supports discontinuing routine MPD in children undergoing mastoidectomy.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Wound Management
Background:
- Mastoid pressure dressings (MPDs) are traditionally used after mastoidectomy.
- Their necessity in preventing post-operative complications and pain in children is not well-established.
Purpose of the Study:
- To evaluate the efficacy of omitting mastoid pressure dressings (MPDs) in pediatric mastoidectomy patients.
- To compare post-operative pain and wound complications between children who received an MPD and those who did not.
Main Methods:
- A retrospective controlled study analyzed 135 pediatric mastoidectomy cases from 2010-2021.
- Patients were divided into two groups: those who received an MPD (n=91) and those who did not (NMPD, n=44).
- Wound complications and Visual Analogue Scale (VAS) pain scores at discharge were compared.
Main Results:
- No significant difference in wound-related complications (e.g., surgical site infections, wound dehiscence) was observed between the MPD and NMPD groups (p=0.32).
- Children in the NMPD group reported significantly less post-operative pain, as measured by VAS scores (p=0.02).
Conclusions:
- Routine use of MPDs after pediatric mastoidectomy offers no significant benefit regarding wound complications.
- Abandoning routine MPDs in children following mastoidectomy is supported, with emphasis on meticulous surgical technique for wound healing.
- Omitting MPDs may lead to reduced post-operative pain in pediatric patients.
Objectives:
To assess the efficacy of avoiding mastoid pressure dressing (MPD) on children as a means of preventing discomfort and post-operative pain.
Design:
A retrospective controlled study.
Setting:
All operations were carried out by experienced surgeons using standard techniques, whose custom, not the gravity of any individual case, dictated the use of MPD.
Participants:
Children who underwent mastoidectomy for inflammatory middle ear diseases at a tertiary centre from 2010 to 2021.
Main Outcome Measures:
Wound-related complications and Visual Analogue Scale (VAS) pain scores at discharge were compared between children who had an MPD applied following surgery and those who did not.
Results:
One hundred thirty-five cases were included. The demographic characteristics of the patients and surgical techniques employed were similar for both groups. There were 91 patients in the MPD group and 44 in the non-mastoid dressing (NMPD) group. In the MPD group, five patients developed minor wound dehiscence, eight experienced surgical site infections (SSI), and one patient developed a keloid. In the NMPD group, one patient had an SSI, one patient suffered from a keloid scar, wound dehiscence was observed in one patient, and another one had a local hematoma. Therefore, there were no differences between the groups in relation to post-operative complications (p = .32). Despite these similitudes, the NMPD patients suffered less post-operative pain, as measured by the VAS (p = .02).
Conclusion:
This study shows that no significant benefit is derived from using an MPD after mastoidectomy in children. Surgeons should adhere to principles of appropriate haemostasis and wound closure to prevent post-operative wound complications. Our study supports the abandonment of routine MPD in children following mastoidectomy.
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