Medical packing is a common procedure used in the management of deep or complex wounds. It involves the insertion of a specialized material into a wound cavity or tract to promote healing from the inside out. This technique is typically reserved for wounds that cannot be closed immediately with stitches or staples due to their depth, shape, or the presence of infection.
Defining Medical Packing and Its Purpose
Medical packing refers to the gentle placement of a dressing material, such as gauze, alginate, or hydrofiber, into a deep wound space, tunnel, or cavity. The primary goal is to fill this “dead space” to prevent the wound edges from closing prematurely over an empty area. If the surface of a deep wound were to seal before the tissue underneath had healed, it could trap fluid, debris, and bacteria, leading to a serious infection or abscess formation.
One major purpose is to manage wound drainage, or exudate, by absorbing excess fluid. This absorption prevents the surrounding skin from becoming overly saturated, a condition called maceration, which can impair healing and increase the risk of skin breakdown.
Packing supports healing by secondary intention, which is when a wound heals by growing new tissue from the base upward. By keeping the cavity open and stimulated, the packing encourages the formation of healthy, pink granular tissue. Certain packing materials can assist in debridement, gently removing dead or damaged tissue as the dressing is changed. The material must fill the space completely but be placed loosely, ensuring it does not exert pressure that could restrict blood flow.
Where Packings Are Most Commonly Used
One common application is in the management of abscesses or surgical wounds that have been opened for incision and drainage (I&D). For these wounds, packing ensures continuous drainage and prevents the wound from sealing until the infection has cleared and the cavity has begun to fill with healthy tissue.
Packing is frequently used in deep, full-thickness injuries, such as diabetic foot ulcers or severe pressure injuries, which often have significant depth or tunneling. The material helps to maintain a moist environment in the wound bed, which is conducive to the body’s natural healing processes. Specialized nasal packing is used in ear, nose, and throat procedures to control severe nosebleeds, or epistaxis, by applying direct pressure to the bleeding vessels.
In dentistry, packing may be utilized after a tooth extraction, particularly in cases of a dry socket, to protect the exposed bone and promote healing. The specific material used, such as plain gauze, alginate, or antimicrobial-impregnated strips, is selected based on the wound’s location, the amount of fluid drainage, and the presence of infection.
Managing and Removing the Packing
For the patient or caregiver, the management of a packed wound focuses on maintaining cleanliness and monitoring the healing progress. Dressing changes are typically required daily or every other day, with the frequency depending on the volume of drainage from the wound. The first step of care is careful hand washing and the removal of the old outer dressing and the packing material.
It is essential to confirm that all of the old packing is removed during the dressing change, as any material left behind can obstruct drainage and lead to a new infection. If the packing material adheres to the wound bed, it should be moistened with sterile saline or water to prevent trauma to the new, fragile tissue upon removal. The new packing material is then moistened, gently squeezed to remove excess solution, and loosely placed into the wound cavity to fill the space without creating tension.
Patients must monitor the wound site closely for signs of complications, which signal a need to contact a healthcare provider. These signs include increased pain, swelling, warmth, or redness spreading away from the wound edges. A foul odor or a significant increase in the amount or thickness of the drainage, especially if it appears pus-like, can indicate a worsening infection. The packing is usually stopped when the wound base shows healthy granulation tissue and the depth has decreased significantly, often to less than one to two centimeters.