Is it appropriate to pack a non-healing abdominal wound with Betadine (povidone-iodine) gauze and cover with a foam dressing?

Betadine Gauze Packing is NOT Appropriate for Non-Healing Abdominal Wounds

For non-healing abdominal wounds, you should use negative pressure wound therapy (NPWT) with specialized foam-based dressing systems rather than Betadine gauze packing, as foam-based NPWT is an independent predictor of successful wound closure while gauze packing has no published evidence supporting its use in abdominal wound management. 1

Why Gauze Packing Fails in Abdominal Wounds

The International Journal of Surgery explicitly states there are no publications regarding the use of gauze as a wound filler for temporary abdominal closure or complex abdominal wounds. 1 This absence of evidence is particularly damning given that:

• Gauze does not compress under negative pressure, eliminating the critical "splinting effect" that prevents lateral retraction of the abdominal wall and loss of domain 1
• Surgical towels and other non-foam materials used in improvised "vac-pac" techniques are not independent predictors of early fascial closure, unlike foam-based NPWT 1, 2
• Prospective comparative studies demonstrate significantly increased fascial closure rates with commercial foam products versus improvised alternatives 2

The Betadine Problem

While povidone-iodine has some role in wound care, its use in packing non-healing abdominal wounds is problematic:

• Betadine solution and ointment do not interfere with healing in superficial wounds when used appropriately 3, 4
• However, Betadine is primarily studied for superficial infected ulcers and chronic venous wounds, not complex abdominal wounds 4, 5
• Recent evidence (2024) suggests limited effectiveness of povidone-iodine for wound care outcomes, with the scoping review concluding PV-I is not highly recommended for wound care 6
• Betadine-soaked gauze provides no mechanical advantage for wound closure, fluid management, or prevention of adhesions—all critical in abdominal wounds 1

What You Should Do Instead

Use specialized foam-based NPWT systems (Grade B recommendation) with the following approach: 1, 2

For Open or Dehisced Abdominal Wounds:

• Apply a non-adherent interface layer to protect exposed organs and prevent bowel adhesions (this is mandatory—GPP recommendation) 1
• Use polyurethane foam that compresses under negative pressure to provide medial traction and splinting 1, 2
• Set continuous NPWT at 50-80 mmHg (lower pressures for vulnerable patients) 2
• The system should evacuate approximately 800ml of fluid to prevent pooling 2

For Closed Incisions at Risk:

• Apply incisional NPWT on the closed wound (Grade B recommendation) 1
• This significantly reduces wound complications including dehiscence and infection compared to standard gauze dressings 1

Critical Timing Considerations:

• You have a 7-10 day window for primary fascial closure before fixity develops 1
• NPWT can extend this window, with successful closures reported as late as 21-49 days 1

Critical Pitfalls to Avoid

Never apply foam directly to dry wound beds—use a non-adherent silicone contact layer moistened with normal saline between the wound bed and foam 2

Failure to use a non-adherent interface layer exposes the patient to significant risk of fistula formation from bowel damage during dressing changes 1

Preserve skin integrity by placing wound filler within the wound rather than on top of surrounding skin 1

When Betadine Might Have Limited Role

If NPWT is absolutely unavailable and you must use conventional dressings temporarily:

• Betadine solution (not gauze packing) may provide local antiseptic effect for superficial wound infection 4, 5
• However, this is a suboptimal temporizing measure only
• Compression or appropriate wound closure strategies remain essential 5
• Antimicrobial gauze with polyhexamethylene biguanide shows better bacterial reduction than plain gauze in wounds requiring packing 7

The foam dressing you mentioned should be part of an NPWT system, not used as a passive cover over Betadine-soaked gauze. This combination provides none of the mechanical benefits of true NPWT and lacks evidence for efficacy in abdominal wounds. 1, 2