Evidence‑Based Recommendations for Wound Packing and Dressing Management

1. Indications for Packing

Routine packing of simple cutaneous abscesses (< 5 cm) after incision and drainage does not improve failure or recurrence rates and should be avoided. 1

Thorough irrigation with running tap water or sterile saline until no visible debris remains is recommended for deep or complex wounds. 2
Tap water is equally effective as sterile saline for irrigation, showing comparable infection rates. 2
Povidone‑iodine solutions provide no additional benefit over irrigation alone and may cause systemic complications such as renal impairment, electrolyte disturbances, and thyroid dysfunction; therefore they should be avoided. 4

After cleaning, cover wounds with an occlusive dressing (e.g., film, petrolatum‑impregnated, hydrogel, cellulose or collagen dressings) to promote healing; these dressings achieve superior outcomes compared with dry dressings. 2
Antibiotic‑ or antibacterial‑impregnated dressings do not enhance healing or reduce infection rates in clean wounds and are not recommended. 2
Place wound filler material within the wound cavity rather than on the surrounding skin to preserve skin integrity. 6
For open abdomen or complex surgical wounds, use specialized foam‑based dressing kits (instead of surgical towels) that compress under negative‑pressure therapy and improve fascial closure rates. 6
Apply a non‑adherent interface layer beneath dressings in abdominal wounds to prevent bowel injury and fistula formation during dressing changes. 6
Negative‑pressure wound therapy can actively evacuate > 800 mL of fluid, decreasing fluid pooling and protecting surrounding skin from maceration. 6

Observe for signs of infection—redness, swelling, foul‑smelling drainage, escalating pain, or fever—and promptly remove the dressing, inspect the wound, and seek medical evaluation when any appear. 2
Wounds contaminated with human or animal saliva require urgent medical assessment. 2

Clean the ulcer daily with water or saline. 7
Maintain a moist environment while controlling exudate using a sterile, inert protective dressing. 7
Perform regular debridement in addition to dressing changes. 7

Do not pack simple abscesses routinely, as this increases pain without clinical benefit. 1
Do not use povidone‑iodine for continuous irrigation because systemic absorption can cause serious complications. 4
Do not apply ice directly to wounds; direct icing can induce tissue ischemia. 8
Do not close infected wounds primarily; they should be allowed to heal by secondary intention. [9][10]