From the Research
Packing for an incision and drainage (I&D) wound may not be necessary at all, as recent studies have shown that not packing the wound does not result in increased morbidity and may even reduce pain and the need for pain medications. The decision to remove and replace packing should be based on the individual patient's needs and the specific characteristics of the wound.
When considering the removal and replacement of packing, the following factors should be taken into account:
- The amount of drainage from the wound: heavily draining wounds may require more frequent dressing changes, while wounds with minimal drainage may require less frequent changes 1.
- The presence of healthy granulation tissue: packing should be discontinued when the wound base has healthy granulation tissue and the cavity has decreased in size significantly, usually when the depth is less than 1-2 cm.
- The risk of abscess recurrence: allowing continued drainage while the wound heals from the bottom up can reduce the risk of abscess recurrence.
It is also important to note that negative pressure wound therapy (NPWT) has been shown to be effective in resolving incisional drainage in most wounds after hip arthroplasty, and may be a viable alternative to traditional packing methods 2.
In terms of specific timing, the first dressing change should occur within 24-48 hours to prevent the packing from drying and adhering to the wound bed, which can cause pain and trauma during removal. Subsequent changes can be made daily or every other day, depending on the amount of drainage and the individual patient's needs.
Overall, the key to successful wound management is to prioritize the individual patient's needs and to use the most effective and evidence-based treatments available. The use of packing should be tailored to the specific needs of the patient and the wound, and should be discontinued as soon as possible to promote healing and reduce the risk of complications.