Duration of Iodoform Wound Packing
Iodoform-impregnated gauze packing should be changed once weekly and continued until complete healing of the cavity occurs, which typically ranges from 2-8 weeks depending on wound size and depth. 1
Evidence-Based Packing Duration
The most comprehensive evidence comes from a systematic review of 92 studies involving 386 patients with jaw lesions, which established the standard practice pattern for iodoform packing 1:
- Weekly pack changes are the most common protocol across multiple wound types 1
- Duration continues until cavity obliteration through secondary intention healing 1
- Complete debridement of necrotic tissue typically occurs within 2 weeks in over 60% of cases 2
Mechanism Supporting Extended Use
Iodoform's efficacy for prolonged packing is supported by its unique fibrinolytic activity 2:
- Collagen fiber lysis allows iodoform to break down necrotic debris and macroaggregates of type I collagen 2
- Antiseptic properties provide sustained antimicrobial activity throughout the healing period 1
- This biochemical action explains why weekly changes are sufficient rather than daily changes required for non-medicated packing 2
Critical Safety Considerations
Monitor for iodoform toxicity, particularly in large wounds or immunocompromised patients 1, 3:
- Systemic absorption can cause consciousness disturbance, delirium, tachycardia, and miotic pupils 3
- Plasma iodine levels become elevated (>150 μg/dL indicates toxicity) 3
- Symptoms resolve rapidly after pack removal 3
- Only 2 cases of toxicity were reported across 92 studies, indicating relative safety with appropriate monitoring 1
Comparison to Alternative Packing Strategies
The evidence for wound packing duration varies by wound type:
- Anorectal abscesses: No recommendation can be made for packing duration due to insufficient evidence, and recent data suggests packing may be costly and painful without clear benefit 4
- Vaginal wounds: Packing beyond 24 hours increases infection rates and should be avoided 4
- Surgical wounds: Standard dressings should remain undisturbed for minimum 48 hours unless leakage occurs 4
Iodoform packing represents a distinct category where the antiseptic and fibrinolytic properties justify extended use with weekly changes, unlike non-medicated packing materials 1, 2.
Practical Implementation
For wounds requiring iodoform packing 1:
- Initial placement: Pack cavity loosely to avoid pressure necrosis
- First change: 7 days post-placement
- Subsequent changes: Weekly intervals
- Endpoint: Complete cavity healing or adequate granulation tissue formation
- Formulations used: BIPP (Bismuth Iodoform Paraffin Paste) most common, followed by Whitehead's varnish 1