Some procedures require that you have an open wound, as opposed to a closed (sutured or stapled) wound. The skin overlying an infected or contaminated wound is left open so the deep tissues may heal before the skin is allowed to heal. Premature closure or healing of the skin can result in recurrence of infection. Your wound was left open and not closed because it was judged to be infected or potentially “dirty”.
The open wound has an outer dressing and an inner “packing”, which serve several purposes:
The outer dressing (A)
- Protects the wound and the skin around it from further injury
- Helps keep a moist environment
- Helps prevent contamination from other sources
The inner packing (B)
- Helps remove tissue that is not healing and debris
- Absorbs drainage
- Prevents premature healing of skin
At first, the wound is packed tightly to help prevent bleeding. Latter, the wound is loosely packed to allow the wound to close from deepest portion first.
- 2×2 or 4×4 gauze sponges (Avoid cotton-lined gauze sponges because the fibers may stick to the wound and cause problems).
- Adhesive tape (If you are allergic to adhesive tape, use “silk” or “paper’ tape.)
- Salt water (saline) solution – Purchase saline at the drugstore or you may make your own saline solution. The solution is made by boiling 1 teaspoon of salt in 1 quart of water for 5 minutes. Store solution in a closed glass container (which has been boiled in water for 4 minutes). Cool solution before using.
- Sterile cotton swabs
- Tweezers. Before using tweezers, you should boil them in water for 4 minutes. Then drain the water from the pan and allow them to cool.
- Bacitracin™ or Neosporin™ ointment (optional)
- Plastic Bag for disposing of used dressings
- Sterile Gloves (large wounds only)
Aseptic technique prevents bacteria from invading your supplies and wound. Keep your supplies in their packages until you are ready to use them. A clean work surface and careful hand washing are very important.
Preparing the Work Area
Tables and surfaces in your home normally have dust and some germs. It is best to choose a work area away from household traffic and distraction.
Choose a work surface such as table, TV tray or counter top.
If the surface is washable, clean it with soap and water; dry with a clean towel or paper towel.
If the surface is not washable (wood dresser top), wipe it free of dust and spread a clean
towel or paper towels over the surface.
Avoid coughing or sneezing on the clean surface.
Hand washing and cleansing
Be sure to wash your hands carefully with antiseptic soap or use alcohol based gel hand cleanser before and after each dressing change.
How to remove the dressing and packing:
1. Cleanse your hands thoroughly.
2. Open and prepare all of the needed dressings and supplies. For example, tear the pieces of tape you will use in advance. This is very important if you do not have someone helping you.
3. Loosen and remove the outer dressing by holding onto the skin and pulling the tape off towards the wound. Discard the dressing a plastic bag. (Be sure to keep soiled dressings away from children and pets.)
4. If instructed, soak the packing in water before removing it, using the shower or sitz bath.
This helps prevent bleeding and discomfort when the packing is removed.
5. Slowly remove the packing. Make sure all of packing is removed. Discard the packing in
a plastic bag, keeping it away from children and pets.
How to pack the wound and change the dressing
1. Moisten (do not soak) gauze sponges in a salt water (saline) solution.
2. “Pack” (place sterile gauze) the open wound.
Unfold gauze sponge into a single layer. Pick up the moistened gauze sponge and place the remaining clean, untouched corner into the wound. Continue to pack the gauze into the wound using sterile cotton swabs or clean tweezers. Although the packing should be
tight, it should not forced into the wound. Any gauze ends that do not fit into the wound
should be neatly placed on top of the wound.
Note: Sterile cotton swabs or tweezers are used because the gauze going into the wound must remain sterile. (Sterile gloves are not needed for small wounds.)
Note: If instructed by your doctor, spread a thin layer of Bacitracin or Neosporin ointment on the moistened gauze sponges wound packing. This makes removal of this dressing more comfortable.
To apply a new outer dressing, layer sterile 4 x 4 gauze sponge the wound. Pick them up by the corner only. Cover the wound evenly. Secure the dressing to the skin with tape. Use tape around the outer edges of the dressing (picture framing).
If the wound is large, you may need to pack it with the entire moistened gauze sponge. The part of gauze going into the wound must remain sterile.
Do not touch the sterile gauze sponges or the wound with your fingers – you must wear a sterile glove if you pick up the dressing with your hand. If you intend to use your hand to put the gauze into the wound, you must wear a sterile glove.
Cover the wound packed with sterile saline moistened gauze with dry sterile gauze, then tape. If you are not wearing sterile gloves as you apply the dry gauze, touch only the corner or the dry gauze which will not be close to the open wound.
Answers to commonly asked questions:
1. How often should I change the dressing?
Change as instructed by your doctor. Usually, the dressing is changed two times a day, while there is pus or image. Then, daily dressing changes are done when the wound looks clean.
2. How long do I need to pack the wound?
Wounds are packed until deep tissue is healed. Then, packing is discontinued so skin can come together. Follow the instructions of your doctor or nurse.
When to Call the Doctor
Watch for the following signs and symptoms and notify your physician if these occur:
- Temperature over 101.5 F or chills
- Foul-smelling drainage or fluid from the wound
- Increased redness or swelling of the wound or the skin around it
- Increasing tenderness or pain in or around the wound
Please click on links to the video for the wound size being managed.