From the Guidelines
Wound packing after incision and drainage of an anorectal abscess is not recommended due to lack of evidence supporting its benefits and potential for increased pain and healthcare expense. The use of wound packing in this context is a common practice, but its effectiveness is unclear, and recent studies suggest it may not add benefit to the healing process 1. According to a Cochrane review, the available evidence is limited and of low quality, making it difficult to determine whether wound packing influences time to healing, wound pain, development of fistulae, abscess recurrence, or other outcomes 1. A subsequent multi-center observational study found that packing is costly and painful and does not add benefit to the healing process 1.
Key Points to Consider
- The primary treatment of anorectal abscesses remains surgical drainage, with the timing being dictated by the severity and nature of any sepsis 1.
- 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 1.
- The risk factors associated with recurrence are inadequate drainage, loculations, horseshoe-type abscess, and time from disease onset to incision 1.
- A complete and accurate drainage of the abscess is essential to minimize the risk of recurrence 1.
Clinical Implications
The lack of evidence supporting the use of wound packing after incision and drainage of an anorectal abscess suggests that this practice should be reevaluated. Clinicians should consider alternative approaches to wound management, such as leaving the wound open to heal by secondary intention or using other types of dressings that promote a moist environment and facilitate healing. Ultimately, the decision to use wound packing should be based on individual patient needs and circumstances, and clinicians should be aware of the potential risks and benefits associated with this practice.
From the Research
Wound Packing for Incision and Drainage
- Wound packing is a common practice for incision and drainage (I&D) of soft tissue abscesses, as it is considered the standard treatment for this condition 2.
- The goal of wound packing is to promote healing, reduce the risk of recurrence, and minimize complications 3.
- However, wound packing can be painful and may cause emotional trauma to patients, particularly children 2.
Alternatives to Wound Packing
- Some studies have investigated alternative methods to traditional wound packing, such as the use of high-vacuum wound drainage systems 2 or silver-containing hydrofiber dressings 4.
- These alternatives may offer benefits such as reduced pain, faster healing, and decreased risk of complications 2, 4.
- Vacuum-assisted closure (VAC) therapy has also been used to treat complex wound failures, including those resulting from I&D 5.
Efficacy of Wound Packing
- The efficacy of wound packing in preventing recurrence and promoting healing is still a topic of debate 3, 6.
- Some studies have found that wound packing may not significantly impact failure or recurrence rates after simple I&D 6.
- However, other studies suggest that packing wounds larger than 5 cm may reduce recurrence and complications 3.
Considerations for Wound Packing
- The decision to use wound packing should be based on individual patient needs and the specific characteristics of the abscess 3.
- Factors such as the size and location of the abscess, as well as the patient's overall health and medical history, should be taken into account 3, 6.
- Further research is needed to determine the optimal approach to wound packing and I&D for soft tissue abscesses 2, 6.