Wound Management Guidelines

Introduction to Wound Care

The American College of Emergency Physicians and other medical societies recommend that wound packing is not routinely necessary for most wounds and should be avoided in many clinical scenarios, as current evidence shows it increases pain and healthcare costs without clear benefit to healing outcomes 1, 2

The World Health Organization and other global health authorities suggest that anorectal abscesses should not be routinely packed after drainage, as this practice is costly, painful, and does not add benefit to the healing process 1, 2
The American College of Surgeons recommends that alternative approaches, such as placing a catheter or drain into the abscess cavity that drains into an external dressing, should be considered for anorectal abscesses 1, 2
The American Heart Association suggests that clean superficial wounds should be covered with an occlusive dressing rather than packing, as occlusive dressings result in better wound healing than dry dressings 3, 4
The Infectious Diseases Society of America recommends that bite wounds should not be packed, and infected wounds should not be closed; instead, wounds should be cleansed with sterile normal saline and approximated by Steri-Strips with subsequent closure by delayed primary or secondary intent 5

The World Journal of Emergency Surgery suggests that after complete removal of necrosis in necrotizing soft tissue infections, negative pressure wound therapy (NPWT) should be considered rather than traditional packing, as NPWT improves local wound environment, increases tissue perfusion, reduces edema, and promotes granulation tissue formation 6

The American College of Emergency Physicians recommends that traditional gauze packing should be avoided due to its association with significant pain during dressing changes and increased healthcare expenses 1, 2
The American College of Surgeons suggests that probing for fistulas in anorectal abscesses should be avoided if one is not obvious, as this causes iatrogenic complications 1, 2