In addition, they reported being in more pain at the time of discharge as well as 48 hours post-procedure. They also found that there were no real improvements to using packing, as both groups required the same amount of secondary intervention. 1
Interestingly, in a systematic review by the American Journal of Emergency Medicine, it was demonstrated that packed wounds do result in delayed wound closure, with closure times basically doubled. However, they found that the rate of wound reoccurrence was equal.2
So why do we think it is a good idea to delay wound closure? We've been telling ourselves that it is to prevent the wound from healing too soon, but in actuality this is an unnecessary practice. Having patients return for packing removal can cost them both time and money as they will often have to take off from work to either follow-up in the ED or with their primary-care provider. As the evidence against packing starts to stack up, I find myself using packing less and less in my practice.
I still pack abscesses, but not nearly as frequently as I did when I first started in the ED. Now, I will only pack under certain circumstances. If the abscess is particularly deep, I will pack, often using iodoform if I think the wound will need the assistance of an antiseptic agent. I will also pack if there is a lot of surrounding induration, because there is a good chance the wound will have more purulence in the days to come and need the wicking capabilities of packing. I will also pack if I want the patient to come back so that the wound can be looked at in the next couple of days.
f the patient gives strong indication that they will go home, keep the wound clean, apply a lot of heat and come back at any sign the infection is getting worse, I will not pack. If the patient appears as though they may not be particularly hygienic, not very dedicated to following their discharge instructions, and apt not to come in until they have a raging infection, then I will pack.
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