Wound Care Dressings

Dressings are applied over the top of a healing wound to protect it from friction, catch drainage, and create a moist environment for optimal healing. We are going to run down the basics of standard surgical gauze dressings but want patients to be aware of a whole other world of high tech wound dressings that can lessen packing changes and speed healing. But, first we will cover the basics.

Closed Healing

The is pretty easy for you folks, just keep a clean pad over top of your incision and tape it down. Change it daily and you’re done. There should be no need to add antibiotic ointments like Neosporin or Bacitricin. Wound care professionals tend to not recommend these ointments because they can cause contact dermatitis reactions, the exception being Polysporin (which has much less risk of problems).

Open Healing

As the new tissue grows in the wound bed, it is very fragile and needs to be protected from drying out. It is also important to keep the inside of the wound clean and remove the exudate (exudate is a by-product of healing, it is a gooey greenish-white substance that will look like pus but isn’t – it’s a collection of leftover cells and material that is sloughed off as the body builds new tissue.)

The traditional route is called “packing” with an absorbent cotton gauze. The packing serves three purposes: to debride the wound bed of dead tissue during healing, to absorb the exudate, and to keep the sides of the wound from touching and mending together. Open Healing Pilonidal excision wounds can develop”bridging”, which is the sides of the wound mending together before the bottom has filled in, this can leave dead space at the bottom of the wound and an abscess may form.

Wound Packing

Open wounds that are deeper than 1 inch are traditionally packed with gauze and then a dressing pad taped over top. In many cases, you might be able to get your insurance to cover a home health aid to come to your home twice daily. Other people have spouses/family/significant others do their packing. It is also possible to do your own packing changes, the requirements are a fair bit of flexibility, determination, and mirrors. The first few days of learning to work with a backwards reflection in the mirror are challenging, but after that you get the hang of it quickly.

Not every surgeon uses the packing method. Wounds can heal just fine without packing as well, as long as extra care is taken to prevent bridging or the top healing over too soon. If you are going the no-packing route, make sure you are being seen by a health care professional EVERY WEEK to have the wound evaluated and make sure it is healing correctly. Flushing the wound twice daily to remove exudate is still a requirement.

How to pack your wound (traditional gauze method): Changing the packing can be painful at first. Try to take your pain med 1/2 hour before a packing change. If you have trouble with the gauze sticking to the inside of the wound, try soaking the gauze with warm water (in the shower or using a washcloth) for 10 minutes to loosen up the gauze before removing it. It’s also helpful if you slightly moisten the packing before you put it into the wound – it’s less likely to completely dry out this way.

Supplies you should have ready before you start: scissors, gauze, tape, q-tips.

1. After you have removed the old packing, carefully flush the inside of the wound out to remove all the debris and gunk.
2. Gently pat dry the top area around the wound. The size of your wound will determine how large a piece of gauze you need to put inside.
3. Fold the gauze over at least once, but not so many times that it becomes a wad that is painful when you’ve placed it in the wound.
4. Moisten the gauze slightly and then carefully put it inside the wound. The object is to keep the sides of the wound from touching and you want the gauze to go all the way to the bottom of the wound. Sometimes it is easier to use a Q-Tip to push the gauze all the way down. Obviously, as the wound heals your pieces of gauze packing will get smaller and smaller.
5. Put a pad over the top of the wound and tape it down. You may need to try a series of tapes before you find one that won’t irritate your skin.
6. As noted above, no need for antibiotic ointments.

There is a wide range of next generation wound care products that can be used in place of traditional surgical gauze, these should be covered if prescribed by your doctor. In many cases the old standby will do just fine, but if you have a progressive doctor or don’t seem to be healing as quickly as you should, by all means give some of the Advanced Dressings a try.

Additional Reading

 Gauze Packing of Open Surgical Wounds The Royal College of Surgeons of England 2006

Tape

It is entirely likely that you will complete your Pilonidal treatment with a deep seated hatred of all forms of medical tape; experiment until you find one that works for you. The residue left by the tape can be removed with  Uni-solve Adhesive Remover.

Related Links

This page last updated: February 9, 2016