Management of Open and Draining Wounds Following Excision of Benign Vascular Proliferation

Initial Assessment and Debridement

Sharp debridement with scalpel, scissors, or tissue nippers is the preferred method for removing devitalized tissue, as it is more definitive and controllable than hydrotherapy or topical debriding agents 1
The goal of debridement is to physically excise dead and unhealthy tissue, enabling wound healing and removing potential pathogen reservoirs 1
Only remove devitalized/infarcted tissue and spare normally perfused skin; if skin viability is questionable, preserve it and reassess at subsequent evaluations 3

The wound should be dressed in a manner that allows daily inspection and promotes a moist wound-healing environment 1
No specific type of dressing has proven superior; convenience and cost are important considerations 1, 2
For open draining wounds, negative pressure-assisted wound management (vacuum-assisted closure) may be beneficial to manage drainage, eliminate dead space, and promote healing 4
Superficial incisional wounds that have been opened can usually be managed without antibiotics if there are no signs of systemic infection 5, 6

Antibiotics are generally unnecessary if there is less than 5 cm of erythema and induration, and minimal systemic signs of infection (temperature <38.5°C, WBC count <12,000 cells/μL, and pulse <100 beats/minute) 6
If the patient has temperature >38.5°C, heart rate >110 beats/minute, or erythema extending beyond the wound margins for >5 cm, a short course (24-48 hours) of antibiotics may be required 6
Empiric antibiotic therapy, when needed, should target staphylococci and gram-negative bacilli 4
If a specific microorganism is identified, therapy should be adjusted accordingly 4

Plan the first re-examination within 12-24 hours and repeat evaluations until the wound shows clear signs of healing 3
Re-evaluations should be performed sooner if clinical signs of worsening infection become evident or laboratory parameters worsen (particularly WBC count) 3
Removal of pressure from the wound (off-loading) is crucial to the healing process, especially for wounds on weight-bearing surfaces 1
Choose a device that permits easy inspection of the wound when off-loading is required 1

For wounds with significant drainage, consider vacuum-assisted closure devices to manage exudate and promote granulation tissue formation 4
In cases where open management is needed, once the infection has cleared, the wound can be closed 5
For vascular proliferation excision sites, careful monitoring of hemostasis is important due to the vascular nature of the original lesion 7
Samson class II infections (open, draining wounds) may benefit from vacuum-assisted closure devices and occasionally from a muscle flap to achieve wound coverage, eliminate dead space, and promote healing 4

Evidence is insufficient to recommend routine use of adjunctive treatments such as recombinant growth factors, skin substitutes, or antimicrobial dressings for infected wounds 1
Granulocyte colony-stimulating factors (G-CSFs) do not accelerate resolution of infection but may reduce the need for operative procedures in certain cases 1