OPTIMIZATION OF SURGICAL WOUND CARE AFTER URETHROPLASTY IN CHILDREN WITH HYPOSPADIA

Abstract

Objectives. To develop optimal postoperative wound care tactics for boys with hypospadias. Methods. The patients (128) with hypospadias aged from 11 months to 7 years were examined. The main group A consisted of 83 (64.8%) patients in whom we used a special bandage. It includes layer by layer of soft polyamide net two-sided onlay coated with soft silicone and adhesive properties, abundantly treated with an antimicrobial ointment containing an osmotic agent, sterile absorbent wipes with non-woven material, a circularly applied elastic bandage and an adhesive plaster with porous non-woven material. The dressing usually held up to 5 days. Group B included 45 (35.2%) patients with hypospadias, in whom we used a conventional sterile circular gauze bandage with antimicrobial ointment. The gauze bandage changed daily. For all clinical symptoms the groups were comparable in age. Postoperative wound healing had been monitored for 10 days after urethroplasty. The emphasis was made on such criteria as bleeding with hematoma formation, copious exudate excretion, penis skin hyperemia, «soft» and «dense» edema, drying crust (scab), skin sutures dehiscence, hypergranulation and necrosis. Results. In group A, problems with the skin flap and postoperative wound were detected only in 17 (20.5%) boys on the second or third day after removal of the special bandage. In the postoperative period, 41 (91.1%) patients in group B had «painful» skin changes in the area of the postoperative wound, which appeared almost the next day after surgery. Conclusion. The use of special bandage delays in time the contact of microbiota penis tissues compromised by surgery and the external environment, which, no doubt, improves the healing of skin grafts in the early postoperative period, and therefore reduces the number of urethroplasty complications. What this paper adds For the first time in patients with hypospadias, the process of postoperative wound healing was analyzed depending on the type of dressing. It was established that the use of a long-term bandage with a soft polyamide mesh doublesided pad with a silicone contact layer and adhesive properties compared to a traditional gauze bandage, which was changed daily, optimized the tactics of postoperative wound care in boys with hypospadias and minimized the number of urethroplasty complications.