What wound care principle is important to remember with fistulas?

• A. Don't pack for the first 6-8 weeks — might reduce chance of spontaneous closure
• B. Pack aggressively at first
• C. Use negative pressure immediately
• D. Keep the area completely dry

Answer: (B)

Managing a fistula wound hinges on creating and maintaining the right wound bed for healing. In the early phase, aggressively packing the tract fills dead space, supports ongoing drainage, and keeps the fistula open so it doesn’t prematurely collapse. This approach helps protect the surrounding skin from effluent, provides a stable environment for healing, and allows you to monitor the tract’s length and drainage. As healing progresses, packing can be reduced and adjusted to keep the area moist enough to promote granulation while continuing to manage drainage.

Not packing early leaves a large, unaddressed space that can collect fluid and bacteria, increasing the risk of infection, abscess, and a stubborn, persistent fistula. Negative pressure therapy isn’t routinely started immediately in fistula care because it can draw contents through the fistula and disrupt the tract unless used in carefully selected cases with special techniques. And keeping the area completely dry neglects the need for moisture management to support tissue healing and can contribute to skin breakdown from ongoing drainage.