Your essential guide to wound packing dead space

wound packing

Let’s face it, there is nothing fun, exciting or sexy about this topic.

Wound packing is just a necessary part of performing good wound care treatments in the event your patient has notable depth in their wound. 

However, there is a purpose and a proper way to pack a wound with the goal of promoting healing in the most effective and efficient manner.

What’s the purpose of packing dead space? 

There are a couple important things we accomplish when wound packing dead space.

First, we reduce the potential for abscess formation and premature closure of the wound.

If you think in terms of a surgical wound, if the surgeon fails to re-approximate the wound edges successfully from the bottom up and they inadvertently leave a “space” deep in the tissue. This space becomes a breeding ground for bacteria growth and potential infection, and may lead to potential complications. 

We can apply the same concept to a chronic wound that heals in a manner that leaves “dead space” under the newly closed wound. 

Second, deep, full-thickness wounds have a tendency to heal faster from the sides than the base. Therefore, wound packing helps to promote a bottom-up healing effect, according to Wound Care Advisor.

Now let’s look at the basic principles of properly “packing” the dead space. There are two cute little sayings that encompass what we are talking about:

  • “Fluff, not stuff”
  • “Lightly, not tightly” 

Proper wound packing principles

Here are three basic principles to adhere to for successful wound packing.

  1. Choose a product or material that is flexible enough to accommodate all contours of the wound.
  2. Fill the entire depth of the wound to the surface. Do not leave “space” anywhere in the wound.
  3. Loosely place the product or material into the wound so it does not create pressure against the healthy tissue. Too much pressure could lead to decreased blood flow and no new tissue growth.

This process is obviously not complicated, but it is essential in the overall plan to treat the wound.

What should we use to fill dead space?

You should select a product based on factors such as cost-effectiveness, exudate absorption needs, moisture needs, ability to reduce frequency of dressing changes and ease of use.

Let’s take a look at those products and what they bring to the table.

  • Alginates: These dressings are very cost-effective with frequency of dressing change varying between every one to three days depending on exudate amount. They also are very easy to use.
  • Amorphous or impregnated hydrogels: These dressings are both cost-effective and flexible in frequency of dressing change based on the manufacturer and wound characteristics. They will promote a moist wound healing environment. However, they should not be used with moderate to heavy exuding wounds.
  • Wound fillers: These dressings are available in pastes, particles, beads or gels. They also provide a cost-effective option with flexibility in dressing change frequency based on the manufacturer and wound characteristics. They can be used with moderate to heavy exuding wounds.
  • Gauze: These dressings are very cost-effective and allow plenty of flexibility in dressing change frequency. They should be limited to scant to moderate exuding wounds. It would be appropriate to moisten them with saline with low-exuding wounds.

Finally, we want to ensure we secure the primary dressing with an appropriate and cost-effective secondary dressing.

Base your choice of secondary dressing on the frequency you need to change the primary dressing, the need to provide additional exudate absorption and ensuring it is not counterproductive to the primary.

For example, do not use an extended-wear dressing like a foam to secure a filler that you plan to change daily or a hydrogel to fill dead space and then cover it with an absorptive product like a foam.

Remember, good wound care is often just good common sense and logic.

Learn more about wound packing in our Skin and Wound Management course.

wound care

Bill Richlen, PT, WCC, DWC, is a clinical instructor for the Wound Care Education Institute. As a licensed physical therapist, Richlen has experience in advanced wound care consultations in long-term care, outpatient, skilled rehabilitation and home health. He has served as a clinical instructor for physical therapy students, been the director of several large rehabilitation departments, and has been providing multi-disciplinary wound care education to nurses and therapists for more than 17 years. His expertise in diverse settings enhance his role as a clinical instructor. His dynamic and captivating teaching style keeps attendee’s attention throughout each course.

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