The study was conducted in the Department of General Surgery at Christian Medical College and Hospital, Ludhiana, Punjab, India, from 1^st January 2012 to 30^th June 2013. It was a hospital based, time bound, prospective study and included patients with postoperative sutured wounds requiring local wound care. The patients were only included after explanation of the study and who gave written informed consent. Ethical clearance was obtained from the Institutional Ethical Committee (IEC).

The cases were randomized into two groups according to the type of dressing used. Group A included patients with non-occlusive dressings and Group B included patients with occlusive dressings for postoperative sutured wound care. Allocation was concealed till subject had been allotted.

Dressings included the conventional non-occlusive gauzes or the occlusive, non-gauze based materials (opsite, primapore). Patients with open wounds, infected wounds, emergency procedures, outpatient procedures and combinations of occlusive and non-occlusive dressings were excluded from the study.

Wounds were examined for any sign of infection. Wound infection was classified according to the centers for disease control and prevention criteria for defining a surgical site infection as follows [8]:

The parameters studied were pain during dressing change, frequency of dressing change, duration of hospitalization, wound infection, wound dehiscence and cost of dressing.

Pain was scored by the patients during hospitalization after each dressing change on a 10 cm visual analogue scale, ranging from 0 (no pain) to 10 (worst pain imaginable) [9].

The results obtained were statistically analysed by student t-test and Chi-square test and p-value less than 0.05 was considered to be statistically significant. Permuted block randomization was carried out using randomization software (RALLOC). Blocks of four were used.

In our study, out of total 298 patients there were 150 (75 male and 75 female) patients in Group A and 148 (72 male and 76 female) patients in Group B. Majority of the studied patients {115 (38.6%)} were in the age group between 46-60 years and the least number {8 (2.7%)} of them were of ages between 76-90 years. Age groups between 15 to 90 years were included in the study. In all the age group, patients were almost equally randomized to Group A and Group B [Table/Fig-1].

The pain occurring during change of dressing was reported more in the non-occlusive dressing group. In both groups, it was seen that the VAS was usually two and three. Mild pain (score=one) and severe pain (score=five) was rarely reported in both the groups [Table/Fig-2].

We found that the majority of patients, 89 (59.3%) and 142 (95.9%) had once daily dressing change in non-occlusive and occlusive dressing group respectively [Table/Fig-3]. We also found that the non-occlusive dressings were changed sooner than the occlusive ones.

The duration of stay in the hospital was almost equal in the two groups where majority of the patients stayed in the hospital for two to seven days. However, a small number of patients in non-occlusive dressing group also had a more prolonged stay for more than 13 days [Table/Fig-4]. Mean duration of hospital stay for non-occlusive dressing group was 6.59 days while for occlusive dressing group it was 3.71 days. Only a minor number of patients from the group with occlusive dressing stayed in the hospital for longer than 7 days.

Wound infection was reported more in those patients who were treated with non-occlusive dressing (28%) as compared to occlusive dressing (10.1%) [Table/Fig-5].

Wound dehiscence was not a common finding in our study. Only eight (2.7 %) of the overall patients had wound dehiscence and all of them were from non-occlusive dressing group [Table/Fig-6].

On comparing the cost of dressing, it was noted that total cost of dressing used in both the groups was mainly between Rs. 60–500. Amongst these, it was the occlusive group that had more number of patients with a lower cost of dressing. Mean cost of dressing for non-occlusive dressing group was Rs. 365.49/- while for occlusive dressing it was Rs. 265.18/- [Table/Fig-7].

The present study was conducted to assess the clinical outcomes of occlusive and non-occlusive dressings in postoperative sutured wounds.

In the present study, it was observed that the pain occurring during change of dressing was reported significantly more in Group A. This is similar to the finding by Provan A and Phillips TJ who found that the pain was lesser in occlusive type of dressing [10]. This may be due to non-occlusive dressings (particularly gauzes) easily stick to the wound when left in situ and cause pain on removal. This was apparent in our study.

Our results are in agreement with study by Ubbink DT et al., which reported that frequency of dressings changes are significantly lower in Group B patients when compared with Group A patients [11]. Factors contributing for decrease frequency of dressing change in occlusive dressing could be due to the properties of waterproof, conform to body contours, and may stay in place for longer periods of time [12].

In our study, the duration of stay in the hospital was reported significantly more in Group A. This finding is similar to findings by and Mertz PM and Harris B et al., [12,13]. This could be possible as occlusive dressings provide a moist environment, retain wound fluid that contains growth factors, and the potential abilities of proteinases to activate latent growth factors and generate chemotactic peptides through connective tissue breakdown may also contribute to the enhanced healing of occluded wounds [14].

It is generally assumed that occlusive dressing increases the risk for infection by completely sealing the wound and allowing the bacterial count to increase [15,16]. However, we found that the frequency of occurrence of infections were significant more in Group A as compared to Group B. This could be mainly due to the better antibacterial coverage present in the occlusive type. This finding is similar to a study done by Helfman T et al., [17].

In our study, we also found that cost of the dressing of Group A were significantly higher as compared to the Group B. This finding is similar to a study done by Shinohara T et al., [7]. Factor contributing for cost effectiveness of occlusive dressing could be due to association with faster healing rates, fewer dressing changes and less complication rates [18].

This study was limited to postoperative inpatients sutured wounds. Hence, we cannot comment on chronic, open, infected, emergency procedures and outpatient procedures wounds. There is a scope for more elaborate studies involving all kind of wounds.

Occlusive dressings simplify wound care and are an excellent choice in the management of most postoperative sutured wounds. We found superiority of occlusive dressings for postoperative wound care regarding wound healing; wound complication, patient comfort, costs of dressing and nursing time in a clinical setting of surgical patients with sutured wounds. The results of this study have been implemented on our surgical wards and have led to a change in postoperative wound care.