What is the purpose and duration of wound packaging?

From the Guidelines

Wound packaging is used to fill dead space in deep wounds, absorb exudate, and promote healing by secondary intention, and it should remain in place for 24-72 hours, depending on the wound type and amount of drainage. The primary goal of wound packaging is to create a moist environment that promotes healing, while also managing drainage and preventing infection [no direct evidence from 1, but general medical knowledge].

When it comes to wound packaging, the key is to fill the dead space in the wound, absorb exudate, and promote healing by secondary intention. The packaging should be loose enough to allow the wound to drain but sufficient to fill the cavity. Common packing materials include saline-moistened gauze, alginate, or antimicrobial-impregnated gauze.

Some key considerations for wound packaging include:

• The type of wound and amount of drainage
• The need for dressing changes, which typically occur every 1-2 days
• The use of gentle irrigation with normal saline when removing wound packing to prevent disruption of new tissue growth
• The gradual reduction of packing as the wound heals and granulation tissue forms

It's also important to note that wound packaging should continue until the wound bed shows healthy granulation tissue and the depth has significantly decreased. This approach prevents premature closure of the wound surface while the deeper tissues are still healing, which could lead to abscess formation. While the provided evidence 1 does not directly address wound packaging, general medical knowledge and principles of wound care support this approach.

From the FDA Drug Label

The grafted area should be covered with one layer of fine mesh gauze. An eight-ply burn dressing should be cut to the size of the graft and wetted with Mafenide Acetate 5% Topical Solution using an irrigation syringe and/or irrigation tubing until leaking is noticeable Wound dressings may be left undisturbed, except for the irrigations, for up to five days Treatment is usually continued until autograft vascularization occurs and healing is progressing (typically occurring in about 5 days)

The purpose of wound packaging is to cover and protect the grafted area and to keep the wound wet with Mafenide Acetate 5% Topical Solution. The duration of wound packaging is typically up to 5 days, until autograft vascularization occurs and healing is progressing 2.

From the Research

Purpose of Wound Packaging

• The primary purpose of wound packaging is to create and maintain a moist environment that facilitates autolytic debridement, reduces pain, and promotes keratinocyte migration over the wound surface 3.
• Wound dressings can be utilized to control a moist environment for healing, and they can be divided into films, foams, hydrocolloids, hydrogels, and alginates 3.
• The ideal dressing should provide a moist environment, have an optimal water vapor transmission rate (WVTR) and absorptive capacity, protect the wound against trauma and contamination, and be easy to apply and remove 3.

Duration of Wound Packaging

• The duration of wound packaging depends on various factors, including the type of wound, the level of exudate, and the specific dressing used 4.
• Dressing changes can be labor-intensive and expensive, and there is a need to reduce their number per week 3.
• Smart dressings with integrated microsensors and delivery capabilities can allow wireless real-time monitoring and treatment of the wound, reducing the need for frequent dressing changes 3.
• The wear time of the dressing can be assessed without dressing removal or visit to the wound care center, allowing for more efficient wound management 3.

Types of Wound Dressings

• Hydrogel dressings have positive degradation properties, making them a perfect choice for applications where a targeted delivery of bioactive substances to the wound is required 5.
• Hydrogel dressings can be used for chronic wounds, providing a moist environment and promoting wound healing 5.
• Other types of wound dressings, such as foam, films, and hydrocolloids, can also be used, depending on the specific needs of the wound 6.

Infection Prevention

• The use of clean or sterile dressing technique does not affect the incidence of wound infection, according to some studies 7.
• Evidence indicates that the use of clean technique for acute wound care is a clinically effective intervention that does not affect the incidence of infection 7.
• However, there is a lack of evidence in the literature regarding the type of dressing technique for chronic wounds 7.