Packing

What is “packing”, and do I need it?

“Packing” doesn’t mean that your pilonidal cyst is going on a trip! Packing refers to the situation where an abscess (pocket of infection) is drained (lanced) and filled with gauze; or a situation where a surgical wound separates, and is filled with gauze. The concept behind this is that the gauze “packing” keeps the skin from closing over the underlying cavity too quickly. This, hopefully, will prevent the skin healing over an empty cavity, which can then become infected.

The packing is usually a long strip of gauze, sometimes impregnated with a chemical called iodoform. It is usually packed into the cavity by a surgeon, nurse, or wound care specialist using some sort of forceps (tweezers). Inserting the gauze may or may not be painful, depending on how recent the wound or abscess cavity is; the newer the wound, the more sensitive it can be. The same goes for removing the gauze.

Depending on the situation and the preference of the physicians involved, they may require that the packing be left in place for a few days and then removed, removed and replaced every few days, or removed and replaced daily. This may require coming into the ER or clinic for each packing change.

Well…we surgeons all have our own training and experience, and certainly have different opinions. But, in our clinic we rarely use packing in any situation. In general, it actually delays healing by not allowing the wound or abscess cavity to collapse and fill in with normal tissue. Having to change the packing creates a complex and uncomfortable series of encounters, which are rarely necessary. And, the iodoform, which is often used on the gauze is unnecessary as well. There is a theory that it helps fight infection – but there is no evidence that it actually does that.

Yes. Sometimes when a large, acute, abscess is drained, there can be a lot of bleeding from the inflamed, infected tissues. In that case, sometimes the best way to stop the bleeding is to pack it with gauze, and come back in a day or two, when the bleeding has stopped, and remove the gauze.

Of course, you have to follow the instructions of your current healthcare providers. In our clinic, packing is not really a modality that we use for abscesses, or in the rare situations where we have some slight separation of a cleft lift incision. We do not perform open or closed excisions, which surgeons often pack, because we don’t agree that it is an appropriate operation to treat pilonidal cysts or sinuses in any situation.

However, hopefully this discussion will help put the “packing” concept into perspective.