Wound packing is a specialized technique used for deep, open wounds that cannot be closed with stitches. This procedure involves gently filling the wound cavity with a dressing material. The goal is to allow the wound to heal from the base upward, a process known as secondary intention healing. This prevents the formation of a superficial bridge of tissue that could trap fluid or bacteria underneath, which may lead to an abscess. Always seek professional medical advice for any serious or deep injury.
Identifying Wounds That Require Packing
Wound packing is reserved for injuries that extend beyond the superficial layer of skin, creating a significant cavity or “dead space.” These are typically full-thickness wounds involving the loss of both the epidermis and dermis. Examples include deep surgical incisions left open to heal, Stage 3 or 4 pressure ulcers, surgically drained abscesses, and traumatic injuries with tissue loss.
Packing is mandated by the presence of tunneling or undermining, where channels or pockets extend away from the visible wound opening. Packing these areas promotes tissue growth and prevents premature closure of the skin surface. Superficial cuts, scrapes, or wounds that are dry and shallow do not require this procedure and should not be packed. Never attempt to pack a wound if the depth is unknown or if there is uncontrolled arterial bleeding, as this requires immediate emergency medical attention.
Essential Supplies for Wound Packing
Preparation requires a dedicated set of sterile supplies to maintain a clean environment and prevent infection. You will need several pairs of sterile or clean gloves for removing the old dressing and applying the new one. A sterile cleansing solution, most commonly normal saline, is required for irrigation, along with sterile gauze sponges or cotton swabs for cleaning.
The packing material is usually a narrow ribbon gauze or packing strip. This material may be plain or impregnated with agents like iodoform, alginate, or hydrofiber. These materials absorb drainage while conforming to the wound shape. Finally, a secondary, absorbent dressing, such as a sterile gauze pad, is needed to cover the packed wound and secure it with medical tape.
Step-by-Step Procedure for Safe Wound Packing
The process begins with meticulous hand hygiene before donning clean gloves to safely remove the old dressing. The soiled materials and gloves should be immediately disposed of in a plastic bag to contain contaminants. After removal, wash hands again and put on a new pair of sterile gloves to prepare for cleaning.
The wound must be thoroughly cleansed using the sterile saline solution to flush out any loose debris, old drainage, or foreign material. Irrigation should be gentle but effective, ensuring any tunnels or undermined areas are rinsed. Once clean, the wound can be assessed for any changes in size, depth, or the nature of the wound bed.
Inserting the Packing Material
Prepare the packing material by moistening it with the sterile solution, then gently squeezing out the excess so it is damp but not dripping wet. This creates a moist environment within the wound cavity, which is conducive to tissue regeneration. Using a sterile cotton swab, forceps, or a gloved finger, gently insert the packing material into the deepest part of the wound.
The material must be placed into all contours, including any pockets or tunnels, ensuring it is a single, continuous piece to fill the entire space. Fill the cavity completely but loosely, avoiding tight packing that could put pressure on the healing tissue, which can impair blood flow and cause damage. A small portion, or “tail,” must be left visible outside the wound opening to facilitate easy removal during the next dressing change. Once packed, place a sterile, absorbent secondary dressing over the entire site and secure it with tape to protect the wound from external contamination.
Monitoring and Dressing Change Protocol
Following initial packing, the wound requires regular monitoring and dressing changes. The frequency is determined by a healthcare provider based on the amount of wound drainage. Wounds with heavy drainage may require changes multiple times a day, while those with minimal drainage might only need a change every one to three days. The process of removing the old packing must be done with great care to avoid disturbing the delicate new tissue that is beginning to form.
When removing the old dressing, gently pull the exposed “tail” of the packing material to draw the strip out of the wound cavity. If the material adheres to the wound bed, moistening it with saline helps loosen it and prevents trauma to the newly formed tissue. After removal, clean and inspect the wound for changes in the amount or color of the drainage. Drainage should ideally decrease and become clearer as healing progresses.
Recognizing Signs of Complication
Watch for signs that may indicate a worsening infection. These warning signs include increased redness, swelling, warmth, or a noticeable increase in pain around the wound site. A foul odor or a significant change in the color or thickness of the drainage, such as thick yellow or green pus, requires prompt medical attention. Notifying a healthcare provider is also necessary if the packing material is difficult to insert, if the wound appears to be getting larger, or if the packing is inadvertently lost inside the cavity.