Do not Pack Abscesses.pdf

so that pus and other material can drain. If iodoform gauze stripping is used, using a limitedamount of gauze is important, that is, just enough to keep the wound open. Packing the woundfull of iodoform gauze does not improve the outcome, and, in fact, it may worsen the prognosisby creating a large foreign body that may become a nidus of infection. "Please note the bold print above for effect. The very fact that we ask patients and theirfamily members to pack wounds could be the greatest opportunity for a malpractice case amongour clients. I can hear the voices in the court room; “well your honor, I never thought that byhaving a non-medical person insert a non-sterile bacterial wicking cloth into a fresh woundwould become the nidus of infection.”More than half a century (57 years to be exact), has passed and we continue the practiceof packing wounds. We seem to go to great lengths to teach patients and their family memberson how to pack their own wounds (albeit via non-sterile techniques). We might as well ask ourpatients to put Honey on their wounds; at least this has some efficacy [4]. The reviewed of theliterature on the care and feeding of abscesses certainly appears to remove any justification forthe traditional method of packing abscess cavities.Wicking occurs when a piece of cord that conveys liquid by capillary action is placed on or intoa wound site; "the physician put a wick in the wound to drain it". The terminology is a bitsemantic. However, I prefer to place an absorbent material (gauze dressing) on the wound. Thisin turn provides the "wicking action" you are referring to without prolonging the healing process.If you stick anything into a cavity you are technically packing it (or making sausage).Show of hands; How many of you are culturing the wounds, giving antibiotics, or makingbratwurst?Education's purpose is to replace an empty mind with an open one.Malcolm ForbesNo room for you fence huggersDr. C[1] Stewart MP. Laing MR. Krukowski ZH. Treatment of acute abscesses by incision, curettage and primary suturewithout antibiotics: a controlled clinical trial. British Journal of Surgery. 72(1):66-7, 1985 Jan.[2] Tonkin DM, Murphy E, Brooke-Smith M, Hollington P, Rieger N, Hockley S, Richardson N, Wattchow DA.Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity. Dis Colon Rectum. 2004Sep;47(9):1510-4. Epub 2004 Jul 8.[3] Barnes SM. Milsom PL. Abscesses: an open and shut case. Archives of Emergency Medicine. 5(4):200-5, 1988Dec.4 Okeniyi JA, Olubanjo OO, Ogunlesi TA, Oyelami OA.Comparison of healing of incised abscesswounds with honey and EUSOL dressing. J Altern Complement Med. 2005 Jun;11(3):511-3.Additional References

Simms MH. Curran F. Johnson RA. Oates J. Givel JC. Chabloz R. ALexander-Williams J. Treatment of acuteabscesses in the casualty department. British Medical Journal Clinical Research Ed. 284(6332):1827-9, 1982 Jun19.Sorensen C. Hjortrup A. Moesgaard F. Lykkegaard-Nielsen M. Linear incision and curettage vs. deroofing anddrainage in subcutaneous abscess. A randomized clinical trial. Acta Chirurgica Scandinavica. 153(11-12):659-60,1987 Nov-Dec.http://www.emedicine.com/emerg/topic494.htm