Wound Packing: Unpacking the Basics

When you’re presented with a patient with a deep gash or laceration, your first instinct is  to clean  and pack the wound—with wound packing used to manage those wounds with depth or irregular shapes. Standard procedure involves filling the wound cavity with a specialized material to absorb excess fluid and control bleeding.

Of course, the idea of filling their body with a foreign object might not exactly be an enjoyable prospect for the patient. In addition, you may not be deeply familiar with the best way to go about packing various types of wounds. For example, you may care for patients with chronic conditions and therefore treat a lot of ulcers rarely deal with  avulsions.

That’s where this article comes in. Keep reading to review several common wound types and the packing techniques typically recommended for their care, along with a few wound types that should be not be packed at all.

Remember: Depending on your care setting, you don’t always have the luxury of seeing patients at scheduled times. You may need to step in and help wounded patients anytime, so it’s always a good idea to stay prepared!

Why Is Wound Packing Important?

Wound packing is an essential component of wound care and affords patients multiple health benefits.

• Hemostasis: Wound packing helps control bleeding by applying pressure and absorbing excess fluid. This is crucial for preventing blood loss and ensuring proper healing.
• Absorption: By removing excess fluid from the wound, packing helps to prevent the softening and breaking down of surrounding skin. This reduces the risk of infection and promotes a healthy healing environment.
• Debridement: Packing materials can gently remove dead or damaged tissue, which is essential for promoting tissue regeneration and preventing infection.
• Protection: Wound packing creates a barrier between the wound and the external environment, shielding it from infection and further injury. This is particularly important for deep or complex wounds.
• Pain management: By absorbing excess fluid and providing a protective layer, packing can reduce pain and discomfort associated with wounds. This can improve the patient’s quality of life and overall well-being.

By addressing these key factors, wound packing can significantly improve patient outcomes. It can reduce the risk of complications, promote faster healing, and promote better outcomes through the care process.

7 Wound Types and Their Wound Packing Techniques

1. Lacerations

Some practitioners use sterile gauze or a hemostatic dressing to control bleeding and absorb excess fluid with lacerations. For deeper lacerations, consider packing with a wound vacuum dressing or negative pressure wound therapy (NPWT). This type of therapy utilizes suction to draw fluid from the wound, promoting healing and reducing the risk of infection.

2. Crush Injuries

Like with lacerations, sterile gauze or a hemostatic dressing to manage bleeding and absorb excess fluid is most common, especially for more mild injuries. For severe crush injuries, you can also use a wound vacuum dressing or NPWT. These dressings can help remove debris and boost healing in wounds with significant tissue damage.

3. Ulcers

For pressure, venous, and diabetic ulcers, you can generally use hydrocolloid or alginate dressings to absorb excess fluid, promote healing, and protect the wound. In some cases, compression bandages may be useful. For deep ulcers, consider using a wound vacuum dressing or NPWT. These dressings can help reduce pressure on the wound and improve blood flow to the area.

Arterial ulcers are a special case, as they may require more aggressive treatment, including surgical intervention. This is due to the limited blood flow surrounding the wound, which limits healing potential and increases the risk of infection and potential for necrosis.

4. Animal Bites

Animal bite wounds should first be thoroughly cleaned with soap and water. Then curb the bleeding with direct pressure. Bites may not be deep enough to require packing, but if deemed necessary, use sterile gauze or a hemostatic dressing.

5. Abscesses

Abscesses often require incision and drainage. After drainage, you can use wound packing with sterile gauze or a hemostatic dressing to prevent excess bleeding and promote healing.

6. Osteomyelitis

Osteomyelitis, a bone infection, often requires surgical debridement to remove infected issue. After surgery, you may use wound packing to control bleeding and absorb excess fluid. Use sterile gauze or a hemostatic dressing and consider using a wound vacuum dressing or NPWT to help manage the infection and encourage bone healing.

7. Avulsions

For partial avulsions, first attempt to reattach the tissue if possible. For complete avulsions, it’s important to stem bleeding as much as possible with direct pressure. If packing is necessary, use sterile gauze or a hemostatic dressing to control bleeding and absorb excess fluid.

6 Wounds That Should Not Be Packed

Not every wound requires packing of course. For example:

• Superficial wounds are minor injuries that affect only the outer layer of skin, such as cuts, scrapes, and minor burns.
• Closed wounds are injuries without an open break in the skin, such as bruises or contusions.
• Wounds on the neck carry the risk of compromising the airway, causing nerve damage, and increasing the risk of infection when packed.
• Wounds on the chest or abdomen are unlikely to be effectively treated with wound packing, and doing so may delay more effective healing strategies and waste time and wound packing materials.
• Clean wounds are injuries without significant contamination or debris and are less likely to need packing.
• Quick-healing wounds are minor wounds that are expected to heal within a few days and may not require packing as long as they do so.

Though each of these wounds have the potential to become infected or develop complications that may necessitate wound packing, they are generally safe to address with less involved treatments.

However, the wound types below are generally considered unsafe to pack, unless your knowledge and expertise deem it necessary.

1. Neck Wounds

Packing wounds on the neck can be dangerous because there is:

• Risk of airway obstruction. The neck contains the trachea, which is essential for breathing. Packing a wound on the neck could potentially block the airway, leading to difficulty breathing or even suffocation for the patient.
• Potential for nerve damage. The neck also houses numerous nerves that control vital functions like swallowing, speaking, and movement. Packing a wound in this area could damage these nerves, potentially resulting in more serious health complications.
• Increased risk of infection. The neck is a sensitive area with a rich blood supply. Packing a wound here could increase the risk of infection, especially if the wound is deep or contaminated.

2. Chest and Abdomen Wounds

The chest and abdomen carry their own issues when it comes to wound packing, like:

• Potential for internal bleeding. The chest and abdomen contain vital organs like the heart, lungs, liver, and intestines. Packing a wound in these areas could potentially damage these organs and lead to internal bleeding, which can be life-threatening.
• Risk of respiratory distress. Like with the neck, wounds on the chest, especially those near the lungs, can interfere with breathing. Packing these wounds could worsen respiratory distress and make it difficult to breathe.
• Increased risk of infection. The chest and abdomen are also sensitive areas with a rich blood supply. Packing a wound in these regions could increase the risk of infection, especially if the wound is deep or contaminated. The risk of infection was so high that even the advent of anesthesia and its pain management capabilities wasn’t enough to consider abdominal surgery safe to perform.

3. Wounds Near Vital & Sensitive Body Parts

Wound packing near a patient’s eyes, nose, ears, and genitals can be quite dangerous due to:

• Difficulty in assessing the wound. It can be challenging to accurately assess a wound in these areas due to their location and the potential for swelling or bleeding, even for an experienced practitioner. This can make it difficult to determine the extent of the injury and provide appropriate care.
• Risk of damage to sensitive tissues. These areas contain delicate tissues and structures that are easily damaged. Packing a wound in these regions could cause further injury or even lead to loss of function. For example, packing a wound near the eye could damage the cornea or other sensitive structures, leading to vision problems for patients.
• Potential for infection. These areas are also more susceptible to infection due to their proximity to mucous membranes and other openings to the body. Packing a wound here could increase the risk of infection, especially if the wound is deep or contaminated.

4. Deep Wounds with Embedded Objects

You should avoid packing wounds with embedded objects because there is:

• Risk of pushing the object further in. Packing a wound with an embedded object can inadvertently push the object deeper into the tissue, causing more damage and potentially injuring critical structures.
• Increased risk of infection. When an object is embedded in a wound, it creates a pathway for bacteria to enter the body, including bacteria that may already be on the object itself. Packing the wound can trap bacteria and increase the risk of infection.
• Difficulty in removing the object. Once an object is embedded in a wound, it can be difficult to remove without proper medical equipment and expertise. Attempting to remove the object could cause further damage or bleeding.

5. Wounds with Active Bleeding

If a wound has active bleeding, packing the wound may make matters worse. For example:

• Interference with blood clotting. When you pack a wound with active bleeding, you can disrupt the natural clotting process. This can prevent the wound from forming a proper clot that stops the bleeding.
• Difficulty in assessing the wound. Active bleeding can make it difficult to accurately assess the extent of the injury. This can make it challenging to determine the appropriate course of treatment.
• Increased bleeding. Packing a wound can also put pressure on the blood vessels, potentially causing them to rupture and increase bleeding further.

6. Burn Wounds

Wound packing is generally not effective when performed on burn wounds. Here’s why:

• Trapping heat. Wound packing can trap heat from the burn, potentially worsening the injury and causing further damage to the skin and underlying tissues.
• Interfering with healing. Burn wounds require a specific healing environment to promote tissue regeneration. Packing can disrupt this environment and delay healing.
• Increasing the risk of infection. Packing can create an environment that is too moist and can promote the growth of bacteria and increase the risk of infection.
• Causing pain. Packing can be painful, especially for severe burns. This can increase the patient’s discomfort and stress.

Know When Wound Packing Is the Right Move

Wound packing is an essential procedure that can help patients heal, retain limbs, and, in severe cases, save their lives. It’s important to stay abreast of the recommended treatment approaches for all types of wounds as you never know when you’ll encounter a patient with an unfamiliar wound—whether that’s in the clinic or while off the clock!