Should You Pack Stomas Surgically Repaired for Retraction and Necrosis?
No, you should not routinely pack stomas that have been surgically repaired for retraction and necrosis. 1
Evidence-Based Rationale
The most direct guideline evidence addressing wound packing in the acute surgical setting comes from the WSES-AAST guidelines on inflammatory bowel disease management, which explicitly state: "An acute abscess should be adequately drained under general anesthetic, with no routine requirement for wound packing." 1 While this statement specifically addresses abscess drainage, the principle extends to surgical wounds in contaminated fields—packing is reserved only for short-term hemostatic requirements, not routine wound management. 1
Recommended Approach After Stoma Revision Surgery
Immediate Post-Operative Management (First 7 Days)
- Perform daily aseptic wound care with sterile cleansing using 0.9% sodium chloride, sterile water, or freshly boiled and cooled water 2, 3
- Apply sterile Y-dressings under the external fixation plate to absorb drainage and cushion movement 2
- Use only breathable, skin-friendly, solvent-free dressings over the surgical site—never occlusive dressings, as these trap moisture and cause maceration and infection 2, 3
- Monitor daily for bleeding, pain, erythema, induration, leakage, and inflammation during tract formation 2, 3
Alternative First-Week Approach
- Consider glycerin hydrogel or glycogel dressings as a cost-effective alternative, applied the day after surgery and changed weekly rather than daily during the first 4 weeks 2
- This approach significantly reduces infection scores compared to standard daily dressings 2
After Initial Healing (Beyond 7 Days)
- Reduce dressing changes to 1-2 times weekly once the stoma tract is formed and incision healed 2, 3
- Transition to simple soap and tap water cleansing with a simple plaster, or omit dressings entirely and leave the site open 2
When Packing Might Be Considered (Rare Exception)
The only scenario where packing has any role is for short-term hemostatic control if there is active bleeding that cannot be controlled by other means. 1 Even in this circumstance:
- Packing should be temporary and removed within 24-48 hours 1
- The wound should then transition to the standard open healing approach described above
- Never leave packing in place as a routine wound management strategy 1
Critical Pitfalls to Avoid
- Excessive tension on external fixation plates causes tissue ischemia and buried bumper syndrome—maintain 5mm free movement 2, 3
- Insufficient incision size creates pressure necrosis—ensure adequate opening 2, 3
- Occlusive dressings trap moisture and cause maceration—always use breathable materials 2, 3
- Inadequate drying after cleansing promotes skin breakdown—thoroughly dry before applying new dressings 2
High-Risk Patients Requiring Extended Intensive Care
Patients with diabetes, immunosuppression, malnutrition, ascites, or corticosteroid use require daily monitoring beyond the standard 7 days, as tract formation may take up to 14 days instead of 7. 2, 3 Watch for delayed healing and escalate to daily intensive wound care if increased erythema, purulent drainage, persistent leakage, fever, increased pain, or induration develop. 2
Special Consideration: NPWT for Complex Cases
In cases of extensive peristomal wound cavities following stoma revision for necrosis and retraction, negative pressure wound therapy (NPWT) can be used by isolating the stoma and treating the peristomal wound area separately. 4 This approach has demonstrated complete wound closure within 30 days in complex cases where traditional wound care would be inadequate. 4