Why should infected wounds not be closed with a dressing?

Why Infected Wounds Should Not Be Closed with Dressings

Infected wounds should not be primarily closed (sutured/stapled shut) because closure traps bacteria and purulent material inside, preventing drainage and creating an ideal anaerobic environment for bacterial proliferation, which significantly increases the risk of abscess formation, systemic infection, and delayed healing.

The Critical Distinction: Primary Closure vs. Dressing Application

The question conflates two different concepts that require clarification:

Primary Closure of Infected Wounds (Should NOT Be Done)

• Infected wounds must remain open to allow drainage of purulent material and prevent bacterial entrapment 1
• Closing an infected wound with sutures, staples, or adhesive creates a closed space where bacteria multiply rapidly
• This leads to abscess formation, tissue necrosis, and potential systemic sepsis
• Wounds with signs of infection (redness, swelling, foul-smelling drainage, increased pain, or fever) require immediate medical evaluation and should never be primarily closed 1

Dressing Application for Infected Wounds (IS Appropriate)

• Infected wounds SHOULD be covered with appropriate dressings that allow drainage while protecting from external contamination 2
• The dressing should be changed daily during the active infection phase (days 1-7) with local disinfection 2
• Antimicrobial-loaded dressings can reduce wound colonization and improve healing in infected wounds 3

Management Algorithm for Infected Wounds

Initial Assessment and Treatment

• Thoroughly irrigate the wound with running tap water or sterile saline until all debris and purulent material are removed 1
• Do NOT primarily close the wound edges together
• Leave the wound open to heal by secondary intention (from the bottom up) 1
• Apply antimicrobial dressings that allow exudate drainage 3

Wound Care During Active Infection

• Change sterile dressings daily with local disinfection during days 1-7 2
• Monitor for signs of worsening infection: increasing redness, swelling, foul odor, pain, or fever 1
• Systemic antibiotics are required for infected wounds and must be prescribed by a healthcare professional 1

Transition to Healing Phase

• After initial infection control, dressing changes can be reduced to every 2-3 days 2
• Continue monitoring for complete wound edge approximation and absence of infection signs 2
• Washing with soap and water is possible 1-2 weeks after initial treatment 2

Special Considerations for High-Risk Wounds

Bite Wounds and Saliva Contamination

• Human and animal bite wounds have extremely high infection risk and should be evaluated in a medical facility immediately 1
• Early systemic antibiotics are essential to prevent infection from high-risk bites 1
• These wounds should NEVER be primarily closed due to the high bacterial load

Clean Surgical Wounds (Different Context)

• The evidence about dressings for primarily closed surgical wounds (clean, non-infected) is entirely different 1
• For clean surgical incisions that are already closed, standard dressings are sufficient and advanced dressings provide no additional benefit in preventing surgical site infections 1
• These dressings can be removed after 48 hours unless leakage occurs 1

Common Pitfalls to Avoid

Critical Error: Closing an infected wound - This is the most dangerous mistake, as it converts a manageable superficial infection into a deep abscess requiring surgical drainage

Inadequate irrigation - Simple rinsing may not provide sufficient pressure to remove bacterial contamination; thorough irrigation is essential 1

Using occlusive dressings on infected wounds - While occlusive dressings promote healing in clean wounds 1, infected wounds require dressings that allow drainage

Delaying antibiotic treatment - Infected wounds require systemic antibiotics prescribed by a healthcare professional, not just topical treatment 1