Should Surgically Revised Stomas Be Packed with Gauze?
No, surgically revised stoma sites should not be packed with gauze after closure—primary closure without packing is safe and does not increase infection risk, while packing may actually be associated with higher infection rates.
Evidence Against Packing
The strongest evidence comes from a retrospective study of 75 patients undergoing ostomy reversal, which found that all four patients (5.3%) who developed stoma site infections had undergone delayed primary closure with packing, while zero patients who received primary closure developed infections (p = 0.39) 1. This directly contradicts the traditional belief that contaminated stoma wounds require packing to prevent infection 1.
Optimal Closure Technique
Pursestring near-complete closure is superior to both conventional primary closure and packing, based on a multicenter randomized controlled trial of 122 patients 2. This approach demonstrated:
- Significantly lower stoma site infection rate: 2% versus 15% with conventional primary closure (p = 0.01) 2
- No difference in delayed healing or patient satisfaction 2
- Slightly longer time to complete epithelialization (34.6 days vs 24.1 days), but this trade-off is acceptable given the dramatic reduction in infection 2
Post-Closure Wound Management
After surgical revision and closure, follow this evidence-based approach:
First Week (Days 1-7):
- Perform daily aseptic wound care with sterile cleansing using 0.9% sodium chloride or sterile water 3, 4
- Apply sterile Y-dressings or breathable, skin-friendly dressings 3, 4
- Never use occlusive dressings—they trap moisture and cause maceration 3, 4
- Monitor daily for bleeding, pain, erythema, induration, leakage, and inflammation 3, 4
After Initial Healing (Week 2 onwards):
- Reduce to simple soap and water cleansing 1-2 times weekly 3, 4
- Dressings can be completely omitted once the tract is healed 4
- Showering, bathing, and swimming are permitted 3, 4
Critical Pitfalls to Avoid
- Packing the wound: Associated with higher infection rates in the available evidence 1
- Excessive tension on external fixation: Causes tissue ischemia and buried bumper syndrome—maintain 5mm free movement 3, 4
- Occlusive dressings: Trap moisture and promote infection 3, 4
- Inadequate drying: Thoroughly dry the site before applying new dressings 4
High-Risk Patients Requiring Extended Monitoring
Patients with diabetes, immunosuppression, malnutrition, ascites, or corticosteroid use require daily monitoring beyond the standard first week 3, 4. Watch for delayed tract formation, which may take up to 14 days instead of 7 3, 4.
When to Escalate Care
Return to daily intensive wound care if any of these develop after initial healing 4:
- Increased erythema or purulent drainage
- Persistent leakage
- Fever or increased pain
- Induration suggesting infection
- Hypergranulation tissue formation