Wound packing is a specific technique used in wound care to facilitate proper tissue regeneration. It is not a universal solution, but is reserved for wounds requiring healing from the deepest point outward. Understanding these principles is necessary to promote recovery and prevent complications like infection or premature surface closure.
The Purpose of Wound Packing
Wound packing involves gently filling a deep, open wound space with a specialized dressing material. The primary goal is to manage the injury’s internal structure and promote healing by secondary intention. This process means the wound is left open to heal naturally from the base and sides, rather than having the edges closed with sutures.
This technique serves multiple functions necessary for deep wound recovery. Packing helps manage “dead space,” which is a void left within the tissue after injury or surgery. If unfilled, this space can accumulate fluid, creating an ideal environment for bacterial growth and abscess formation. The packing material also absorbs excessive exudate (drainage), maintaining an optimal moisture balance that supports tissue growth and prevents surrounding skin breakdown.
By filling the cavity, the packing material encourages the growth of healthy granulation tissue from the bottom up. This bottom-up healing prevents the surface layer from closing over the deeper cavity before it has filled with new tissue. Premature surface closure can trap bacteria and lead to a worsening infection deep within the wound. The packing also aids in autolytic debridement, gently removing dead or damaged tissue with each dressing change.
Identifying Wounds That Need Packing
The need for packing is dictated by the wound’s depth and structure, necessitating healing by secondary intention. Wounds extending into the subcutaneous tissue or deeper, creating a measurable void, are typically candidates for packing. This includes surgical wounds intentionally left open due to a high risk of infection, or those where the edges cannot be easily approximated.
Specific wound types frequently requiring packing result from the incision and drainage of an abscess. Once infected fluid is released, a cavity remains that must be filled to ensure proper healing. Packing is also mandatory for wounds exhibiting tunneling or undermining. Tunneling describes a narrow channel extending from the main wound surface into deeper tissue, while undermining refers to a wider area of tissue destruction beneath the skin’s edge.
Filling these channels and undermined areas ensures the tissue is supported and heals from the deepest point outward, preventing the surface from closing over hidden damage. Chronic wounds, such as Stage 3 or 4 pressure injuries or certain diabetic foot ulcers, often require this complex treatment method. For these wounds, a gentle probe assessment is necessary to identify the full extent of the hidden spaces before packing begins.
When Packing Is Harmful or Unnecessary
Packing is not appropriate for all open injuries, and using it incorrectly can impede healing. Wounds healing by primary intention, such as clean surgical incisions or simple lacerations closed with sutures or staples, should never be packed. These wounds heal quickly because their edges are brought together; introducing packing would disrupt the delicate closure and increase infection risk.
Shallow wounds affecting only the outer layers of skin, with no significant depth or tunneling, do not require packing. Packing a superficial wound can cause trauma to fragile new tissue and may dry out the wound bed, which is counterproductive to healing. A moist environment is necessary for cell migration and tissue regeneration, and over-packing can lead to tissue damage or pain.
Wounds with active, brisk bleeding should not be packed in the manner described for secondary intention healing. While tight packing is used in emergency first-aid to control hemorrhage, routine wound packing should not be done on an actively bleeding wound. Contraindications also include wounds located on the neck, chest, or abdomen, as packing in these areas risks compromising the airway or being ineffective due to underlying structures.
Materials and Technique for Packing a Wound
The selection of packing material is based on the wound’s characteristics, such as drainage amount and infection presence. Common materials include plain or gauze strips, often moistened with sterile normal saline to create a damp dressing. Specialized options, chosen to manage high levels of exudate or bioburden, include antimicrobial-impregnated gauze, alginates, or hydrofiber dressings.
Proper technique is essential to prevent complications and ensure effective healing. The material must be inserted gently using a sterile cotton swab or gloved finger, filling the entire wound cavity and any tunnels or undermined areas. It is important to fill the space loosely, avoiding over-packing, as excessive pressure can impair blood flow to the wound bed and delay healing.
Only a single piece or length of packing material should be used whenever possible to minimize the risk of leaving a piece behind, which can lead to infection. A small portion of the packing, sometimes called a “wick” or “tail,” must be left extending out of the wound opening for easy and complete removal during the next dressing change. The packing is then secured with a secondary, dry dressing. A healthcare professional determines the frequency of changes, typically every one to two days.