傷口到底可不可以碰水？

以前看教科書. 記得是手術傷口是 24小時之後可以洗澡. 但UPTODATE上面說. 目前並無明確建議

手術後的切口
手術後的傷口通常會放上乾敷料(乾紗), 以膠帶固定, 維持傷口乾燥. 敷料可在48小時內移除
手術後何時可洗澡, 並無明確界定
Postoperative surgical incision – Postoperative surgical incisions (clean, clean-contaminated) are typically covered with a dry dressing that is held in place with an adhesive (eg, tape, Tegaderm). The initial postoperative dressing can be removed within 48 hours, provided the wound has remained dry. The timing with which the patient can resume bathing/showering is not well defined [175,176].

175 Early versus delayed post-operative bathing or showering to prevent wound complications.
176 Postoperative Showering for Clean and Clean-contaminated Wounds: A Prospective, Randomized Controlled Trial.

台灣整形外科醫學會 2019/10/02 醫療新知 有一篇文章. 下面有連結.
傷口到底可不可以碰水？徐矢達（欣藝整形外科診所院長）

高雄醫學大學附設中和醫院外傷科李維哲主任
外傷後傷口清潔與照護
因此，除非手術或是處理傷口的醫師有特別交代，否則縫合後的傷口，只要外觀看起來乾爽，就可以放心清洗或碰水，只要立即除去多於水分，避免長時間潮濕就好了。保持傷處的清潔，也是防止發炎很重要的一步喔！。




Medline ® Abstracts for References 175,176 of 'Basic principles of wound management'


下面是第一篇參考資料.
175 | PubMed TI Early versus delayed post-operative bathing or showering to prevent wound complications. AU Toon CD, Sinha S, Davidson BR, Gurusamy KS SO Cochrane Database Syst Rev. 2015;
BACKGROUND
Many people undergo surgical operations during their life-time, which result in surgical wounds. After an operation the incision is closed using stiches, staples, steri-strips or an adhesive glue. Usually, towards the end of the surgical procedure and before the patient leaves the operating theatre, the surgeon covers the closed surgical wound using gauze and adhesive tape or an adhesive tape containing a pad (a wound dressing) that covers the surgical wound. There is currently no guidance about when the wound can be made wet by post-operative bathing or showering. Early bathing may encourage early mobilisation of the patient, which is good after most types of operation. Avoiding post-operative bathing or showering for two to three days may result in accumulation of sweat and dirt on the body. Conversely, early washing of the surgical wound may have an adverse effect on healing, for example by irritating or macerating the wound, and disturbing the healing environment.


OBJECTIVES
To compare the benefits (such as potential improvements to quality of life) and harms (potentially increased wound-related morbidity) of early post-operative bathing or showering (i.e. within 48 hours after surgery, the period during which epithelialisation of the wound occurs) compared with delayed post-operative bathing or showering (i.e. no bathing or showering for over 48 hours after surgery) in patients with closed surgical wounds.


SEARCH METHODS
We searched The Cochrane Wounds Group Specialised Register (30th June 2015); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); The Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process&Other Non-Indexed Citations); Ovid EMBASE; EBSCO CINAHL; the metaRegister of Controlled Trials (mRCT) and the International Clinical Trials Registry Platform (ICTRP).


SELECTION CRITERIA
We considered all randomised trials conducted in patients who had undergone any surgical procedure and had surgical closure of their wounds, irrespective of the location of the wound and whether or not the wound was dressed. We excluded trials if they included patients with contaminated, dirty or infected wounds and those that included open wounds. We also excluded quasi-randomised trials, cohort studies and case-control studies.

DATA COLLECTION AND ANALYSIS
We extracted data on the characteristics of the patients included in the trials, risk of bias in the trials and outcomes from each trial. For binary outcomes, we calculated the risk ratio (RR) with 95% confidence interval (CI). For continuous variables we planned to calculate the mean difference (MD), or standardised mean difference (SMD) with 95% CI. For count data outcomes, we planned to calculate the rate ratio (RaR) with 95% CI. We used RevMan 5 software for performing these calculations.

MAIN RESULTS
Only one trial was identified for inclusion in this review. This trial was at a high risk of bias. This trial included 857 patients undergoing minor skin excision surgery in the primary care setting. The wounds were sutured after the excision. Patients were randomised to early post-operative bathing (dressing to be removed after 12 hours and normal bathing resumed) (n = 415) or delayed post-operative bathing (dressing to be retained for at least 48 hours before removal and resumption of normal bathing) (n = 442). The only outcome of interest reported in this trial was surgical site infection (SSI). There was no statistically significant difference in the proportion of patients who developed SSIs between the two groups (857 patients; RR 0.96; 95% CI 0.62 to 1.48). The proportions of patients who developed SSIs were 8.5% in the early bathing group and 8.8% in the delayed bathing group.


AUTHORS' CONCLUSIONS
There is currently no conclusive evidence available from randomised trials regarding the benefits or harms of early versus delayed post-operative showering or bathing for the prevention of wound complications, as the confidence intervals around the point estimate are wide, and, therefore, a clinically significant increase or decrease in SSI by early post-operative bathing cannot be ruled out. We recommend running further randomised controlled trials to compare early versus delayed post-operative showering or bathing.

AD Public Health Research Unit, West Sussex County Council, The Grange, County Hall Campus, Tower Street, Chichester, West Sussex, UK, PO19 1QT. PMID 26204454




下面是第二篇參考資料.
176| PubMed TI Postoperative Showering for Clean and Clean-contaminated Wounds: A Prospective, Randomized Controlled Trial. AU Hsieh PY, Chen KY, Chen HY, Sheng WH, Chang CH, Wang CL, Chiag PY, Chen HP, Shiao CW, Lee PC, Tai HC, Chien HF, Yu PJ, Lin BR, Lai YH, Chen JS, Lai HS
SO Ann Surg. 2016 May;263(5):931-6.

OBJECTIVETo evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care costs starting 48 hours after surgery.

BACKGROUNDShowering after surgery is a controversial issue for wound care providers and patients. We investigated the benefits and detriments of showering for postoperative wound care.

METHODSPatients undergoing thyroid, lung, inguinal hernia, and face and extremity surgeries with clean or clean-contaminated wounds were included. The patients were randomized to allow showering (shower group) or to keep the wound dry (nonshower group) for postoperative wound care starting 48 hours after surgery. The primary endpoint was the rate of surgical wound infection. The secondary endpoints included the wound pain score, satisfaction with wound care, and cost of wound care.

RESULTS
Between May 2013 and March 2014, there were 222 patients randomized to the shower group and 222 to the nonshower group. Two patients in each group were lost to follow-up. There were 4 superficial surgical site infections in the shower group and 6 in the nonshower group (4/220, 1.8% vs 6/220, 2.7%, P = 0.751). Postoperative pain scores were comparable between the 2 groups. Patients in the shower group were more satisfied with their method of wound care, and their wound care costs were lower when compared with the nonshower group.

CONCLUSIONS
Clean and clean-contaminated wounds can be safely showered 48 hours after surgery. Postoperative showering does not increase the risk of surgical site complications. It may increase patients' satisfaction and lower the cost of wound care.


AD *Department of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan†Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan‡Institute of Statistical Science, Academia Sinica, National Taiwan University College of Medicine, Taipei, Taiwan§Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan¶Department of Medical Research, National Taiwan University College of Medicine, Taipei, Taiwan ||Department of Traumatology, National Taiwan University College of Medicine, Taipei, Taiwan **School of Nursing, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
PMID
26655923