From the Research
Wound packing for hidradenitis suppurativa should be performed after incision and drainage using sterile, antimicrobial-impregnated gauze or ribbon material, as recommended by recent studies 1. The packing should be placed loosely to fill the cavity without causing pressure on surrounding tissues, allowing proper drainage and preventing premature closure of the wound surface. Some key points to consider when performing wound packing for hidradenitis suppurativa include:
- Using sterile, antimicrobial-impregnated gauze or ribbon material to reduce the risk of infection
- Placing the packing loosely to fill the cavity without causing pressure on surrounding tissues
- Changing the packing daily or every other day, depending on drainage amount, with more frequent changes recommended for heavily exudating wounds
- Gently irrigating the wound with sterile saline or antiseptic solution before each packing change
- Continuing packing until the wound shows healthy granulation tissue and decreased drainage, usually for 5-14 days
- Promoting healing from the inside out (secondary intention) to prevent abscess recurrence
- Managing pain during packing changes with topical lidocaine or oral analgesics administered 30-60 minutes before the procedure as needed
- Teaching patients proper wound care techniques if they will be performing packing changes at home It's also important to note that the combination of oral clindamycin with rifampicin is recommended by European guidelines as a first-line treatment in moderate-to-severe hidradenitis suppurativa (HS) 2. However, the most recent and highest quality study on wound packing for hidradenitis suppurativa is from 2021, but the study focused on systemic antibiotics in hidradenitis suppurativa, and the best study on wound packing is from 2018 1. In terms of wound care management, a tier system has been proposed, with silver-impregnated foam considered the most optimal HS wound care dressing due to its ideal characteristics, including cost-effectiveness, ease of accessibility, and improvement in quality of life for patients suffering from HS 1.