|Why have I never packed a wound before? Today I had a young women with Hidradenitis present 2 days after a visit to the ED where a large lesion on her labia was I&D’d, packed with iodoform gauze, and she was started on TMP/SMX. She still had the packed gauze in place and was told to follow up with Dermatology to have it changed. We don’t stock iodoform in clinic, so I couldn’t change it for her. This made me think – why do we not routinely pack abscesses and why do many emergency physicians seem to always pack abscesses? Traditional teachings are that packing abscesses encourages more complete drainage by preventing premature cavity closure and the use of iodoform is antibacterial. I found one prospective, randomized, single-blinded trial of 48 patients (O’Malley GF et al. Routine packing of simple cutaneous abscesses is painful and probably unnecessary. Acad Emerg Med. 2009 May;16(5):470-3.) that found no difference in outcome between packed and non-packed abscesses; however, discovered that packed wounds were associated with increased pain and pain medication use. Perhaps, in the case of hidradenitis, packing could have a negative effect by encouraging epithelialization of the cavity and promoting sinus tract formation.
I’m interested in your thoughts and practices and those of other dermatologists. Should I start stocking iodoform gauze or rather forceps to remove it?