What Wounds Should Not Be Packed? Contraindications Guide
What wounds should not be packed?
The Quick Answer
Avoid packing: **clean, shallow wounds** healing by primary intention, wounds expected to close within 3–5 days, wounds with **active bleeding** (packing obscures hemorrhage assessment), **arterial insufficiency wounds** (pressure compromises marginal perfusion), and wounds with **exposed vessels/nerves**. Packing is indicated only for deep wounds with dead space, tunnels, or undermining where surface closure would trap infection or prevent healing from the base upward.
Why We Ask This
Well-intentioned clinicians pack all open wounds believing 'filling space prevents infection,' inadvertently causing pressure necrosis in wounds with compromised blood flow or delaying closure in wounds capable of rapid epithelialization—both scenarios prolonging healing unnecessarily.
The Practical Science
Packing serves two purposes: preventing premature surface closure over unhealed depth, and absorbing exudate from wound base. Wounds without significant depth or undermining heal faster without packing—epithelial cells migrate more efficiently across moist, unpacked surfaces than through gauze interstices.
In Clinical Practice
A 1cm superficial abrasion requires only a non-adherent primary dressing with absorptive secondary layer—packing would impede epithelial migration and increase dressing change pain. Conversely, a 5cm deep diabetic foot ulcer with sinus tracts requires loose packing to enable granulation from depth outward.
References & Context
Wound Packing: Unpacking the Basics - Net Health"Clean wounds are injuries without significant contamination or debris and are less likely to need packing. Quick-healing wounds are minor wounds that are expected to heal within a few days and may not require packing as long as they do so.Nov 18, 2024"