When is wound packing indicated?

From the Guidelines

Wound packing is not recommended as a routine practice after anorectal abscess drainage, as its effectiveness in reducing time to healing, recurrence, or other outcomes is unclear and may cause additional pain and healthcare expense. The use of wound packing in anorectal abscess management is a topic of debate, with some authors suggesting its potential benefits in promoting healing and preventing recurrence, but the current evidence does not support its routine use 1.

The primary treatment of anorectal abscesses remains surgical drainage, with the timing being dictated by the severity and nature of any sepsis. In general, the incision should be kept as close as possible to the anal verge to minimize the length of a potential fistula, while still providing adequate drainage and avoiding sphincteral damage. A recent Cochrane review included two studies for a total of 64 randomized participants and found that the use of internal dressings (packing) for the healing of perianal abscess cavities has no clear benefits 1.

Some key points to consider when managing anorectal abscesses include:

• The high rate of recurrence after drainage, which can be as high as 44% 1
• The risk factors associated with recurrence, such as inadequate drainage, loculations, horseshoe-type abscess, and time from disease onset to incision 1
• The importance of complete and accurate drainage of the abscess to minimize the risk of recurrence 1
• The potential for wound packing to cause additional pain and healthcare expense, without clear benefits in terms of healing or recurrence prevention 1

In summary, the decision to use wound packing after anorectal abscess drainage should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, and should not be considered a routine practice. The current evidence suggests that wound packing may not be necessary for most patients, and its use should be carefully considered and discussed with the patient.

From the Research

Indications for Wound Packing

Wound packing is indicated in various situations, including:

• Wounds that are allowed to heal by secondary intention, which usually involves repeated packing and dressing of the raw wound surfaces 2
• Acute traumatic wounds with soft tissue loss, where negative pressure wound therapy (NPWT) with gauze or foam dressing can be used 3
• Wounds that require packing, such as diabetic foot ulcers, pressure ulcers, and delayed closure surgical wounds, where antimicrobial gauze can be used to reduce bacterial colony counts 4
• Chronic wounds, such as venous leg ulcers, diabetic foot ulcers, and pressure ulcers, where polyabsorbent fibre dressings can be used to promote wound healing and reduce sloughy tissue 5

Key Considerations

When considering wound packing, the following factors should be taken into account:

• The type of wound and its etiology
• The presence of infection or heavy microbial contamination
• The need for debridement or removal of sloughy tissue
• The choice of dressing material, such as gauze, foam, or polyabsorbent fibre dressings
• The potential benefits and limitations of different dressing materials, including their ability to promote wound healing, reduce infection, and manage pain 3, 4, 6, 5

Dressing Options

Various dressing options are available for wound packing, including:

• Gauze dressings, which can be used with or without antimicrobial agents 2, 3, 4
• Foam dressings, which can be used in NPWT for acute traumatic wounds 3
• Polyabsorbent fibre dressings, which can be used to promote wound healing and reduce sloughy tissue in chronic wounds 5
• Antimicrobial gauze dressings, which can be used to reduce bacterial colony counts in wounds that require packing 4