Should a wound be packed after incision and drainage (I&D)?

From the Guidelines

Packing a wound after incision and drainage is not recommended as it is unclear whether it influences time to healing, wound pain, development of fistulae, abscess recurrence, or other outcomes, and may be costly and painful for patients 1. When considering wound management after incision and drainage, it is essential to prioritize evidence-based practices that promote optimal healing and minimize complications.

Key Considerations

• The use of packing after anorectal abscess drainage remains unproven, with some studies suggesting it may reduce time to healing and recurrence, but also causing pain and additional healthcare expense 1.
• A recent Cochrane review found that the available evidence is limited and of low quality, making it difficult to draw firm conclusions about the effectiveness of packing 1.
• A subsequent multi-center observational study found that packing is costly and painful and does not add benefit to the healing process 1.

Evidence-Based Recommendations

• Given the lack of strong evidence supporting the use of packing, it is recommended to avoid this practice and instead focus on promoting moist wound healing and minimizing trauma to newly forming tissue.
• If packing is deemed necessary, it should be used judiciously and with careful consideration of the potential benefits and drawbacks, taking into account the individual patient's needs and circumstances.
• Further research, such as the ongoing PPAC2 trial, is needed to provide more definitive guidance on the use of packing after anorectal abscess drainage 1.

From the Research

Wound Packing After Incision and Drainage

• The decision to pack a wound after incision and drainage (I&D) is a topic of debate, with varying opinions and practices among medical professionals 2, 3, 4, 5, 6.
• Studies have investigated the effectiveness of wound packing in reducing recurrence rates and promoting healing, with some suggesting that packing may not be necessary for uncomplicated abscesses 3, 5, 6.
• A study published in 2018 found that antibiotic agents are not necessary for uncomplicated subcutaneous abscesses after I&D, and that these cases can be managed safely on an outpatient basis without any increase in morbidity 2.
• Another study published in 2016 reviewed the available evidence on wound packing and post-procedural antibiotics, and found that there is data to support the elimination of abscess packing and routine avoidance of antibiotics post-I&D in immunocompetent patients 3.
• However, some studies suggest that packing wounds larger than 5 cm may reduce recurrence and complications 4, 6.
• A randomized trial published in 2012 found that wound packing does not appear to significantly impact the failure or recurrence rates after simple I&D, and that larger studies are needed to better validate the equivalency of these two strategies 5.
• Overall, the evidence suggests that wound packing may not be necessary for all abscesses, but may be beneficial in certain cases, such as larger abscesses or those with high risk features 3, 4, 6.

Key Findings

• Wound packing may not be necessary for uncomplicated abscesses 2, 3, 5.
• Packing wounds larger than 5 cm may reduce recurrence and complications 4, 6.
• Antibiotic agents are not necessary for uncomplicated subcutaneous abscesses after I&D 2.
• The decision to pack a wound after I&D should be made on a case-by-case basis, taking into account the size and complexity of the abscess, as well as the patient's overall health and risk factors 3, 4, 6.