Iodoform packing is a medicated gauze strip used in the management of deep, draining wounds that must heal from the inside out. This sterile material is infused with iodoform, a compound containing iodine, making it suitable for treating abscess cavities, surgical wounds, or sinus tracts. Its application is reserved for wounds requiring both infection control and a mechanical means of promoting proper healing.
The Function of Iodoform Packing in Wound Management
The purpose of iodoform packing is two-fold, providing both chemical and mechanical benefits to the wound bed. Chemically, the iodoform compound acts as an antiseptic, slowly releasing iodine within the wound environment. This iodine is effective at reducing the bacterial load, which helps prevent infection, and the strong odor also helps mask wound odor.
Mechanically, the gauze strip serves as a wick to absorb and draw away excess fluid from the deepest part of the wound cavity. This wicking action prevents fluid buildup, which can slow the healing process and promote bacterial growth. The presence of the packing also prevents the wound edges from prematurely closing over the opening. This forces the wound to heal from the base up, a process called secondary intention, which is necessary for deep wounds.
The material also has a role in debridement, facilitating the breakdown of collagen fibers within necrotic debris. By combining antimicrobial action, fluid management, and mechanical support, the strip creates a more favorable environment for healing. This makes it a standard choice for deep, often infected, wounds that require careful management.
Wetting the Strip: Rationale for Moist vs. Dry Application
The decision to wet the iodoform strip balances the need for maximum wicking capacity against the risk of patient discomfort and wound trauma. Iodoform packing is designed to be inserted dry because wound fluid naturally moistens the strip, maximizing its ability to absorb fluid in highly draining wounds. When the dry strip absorbs fluid, the iodoform is activated, allowing the antiseptic iodine to be released into the surrounding tissue. Some protocols emphasize that pre-wetting the strip can wash away active iodoform, potentially reducing its antiseptic properties and prioritizing aggressive fluid removal.
However, a dry strip remaining in a wound for 24 hours, especially one with low drainage, can dry out and become firmly adhered to the healing tissue. This adherence causes significant pain and trauma to the wound bed when the packing is removed. Trauma during dressing changes disrupts new tissue growth, which can delay the healing timeline. For this reason, many practitioners lightly moisten the strip with sterile saline or water before insertion, or certainly before removal, to reduce this risk. Moistening the strip makes it more pliable, easing insertion and preventing the gauze from sticking to the wound bed upon removal.
If the strip feels stuck during the removal process, soaking it with sterile saline is recommended to gently release it and prevent bleeding or damage. The goal is to prevent adherence and trauma, while still allowing the strip to perform its primary function of drawing out fluid and providing antiseptic action.
Safe Procedures for Packing Insertion and Removal
Regardless of the choice to moisten the strip before insertion, the procedure requires strict adherence to sterile technique to prevent the introduction of bacteria into the wound. The process begins with thorough hand hygiene and the use of sterile gloves and instruments. The wound should be gently irrigated with sterile saline to clean the cavity and remove any debris before the new packing is introduced.
The strip must be inserted loosely into the cavity, using sterile forceps to place the material directly into the deepest parts of the wound. It is important to avoid tightly packing the wound, as this can create excessive pressure, which impairs blood flow and can damage the surrounding tissue. The packing should fill the space but still allow room for drainage to escape.
A portion of the iodoform strip, often called the “tail,” must always be left hanging outside the wound opening. This tail is necessary for easy location and removal of the entire strip in a single piece. If multiple strips are needed for a large cavity, they are often tied together beforehand to ensure no pieces are left behind.
The packing is changed daily, or as directed by a healthcare professional, because the antiseptic properties of the iodoform diminish within 24 to 48 hours. During removal, the tail is grasped gently, and the strip is pulled out slowly while monitoring the patient for pain. If any resistance is felt, the area should be moistened with sterile saline to prevent tearing the new tissue.