How to Pack and Re-Pack Hidradenitis suppurativa (HS) Wounds

Let’s face it, being members of the Hidradenitis Suppurativa (HS) community we all know just how deep HS runs. Both emotionally and physically, it can leave us with huge holes in its wake and in our case, quite literally, we are left with deep sinus tracts that, in many cases, need to be packed and dressed.  During my conversations with many HS patients, the topic of packing and dressing comes up again and again. For some reason the information isn’t readily available, and that needs to change. So in an attempt to bring this to the surface (no pun intended) I am writing this article with all of you in mind.

Deep wounds require special dressings and an understanding of how to pack those wounds to encourage healing and to reduce the risk of a bacterial infection. Proper wound packing is crucial for tissue growth at the wound’s base, to prevent the formation of abscesses and the premature closure of the wound.

Please keep in mind there is no medical cure for Hidradenitis Suppurativa, nor is there a way to stop the abscesses that flare with it. But by following the instructions below, and the individual instructions of your doctor; you can promote healthy wound healing.


Supplies

Before gathering your wound care supplies be sure to clean all surfaces that may come into contact with the supplies. Use soap to wash your hands and the area where the supplies will be. Once you have properly cleaned these surfaces, get the following materials:

  • Non-adhesive gauze, pads, packing strips and other materials designed to manage drainage
  • Sterile rubber or vinyl gloves
  • Sterile wound-wetting solution
  • Clean towel
  • Clean scissors (used only for wound care dressing changes)
  • Clean small bowl
  • Medical tape
  • Cover dressing to place over the wound after packing it
  • Cotton swabs (Q-Tips)
  • Plastic bag for used wound dressings

Steps

After you have your supplies, you can begin to replace old packing strips. The following steps established by the American Association for the Surgery of Trauma [1] explain how to pack wounds:

  1. Place the clean towel down and set the bowl on the towel.
  2. Pour sterile wetting solution into the bowl, using enough to wet your packing strips generously.
  3. Using clean scissors, cut the appropriate length of packing strip needed to pack the wound. (You can either wait until after it’s packed to cut off the excess an inch away from wound, or measure a previously removed strip.)
  4. Put the piece of packing strip into the bowl containing the wetting solution.
  5. Cut medical tape into strips that will secure the outer dressing of your wound.
  6. Gently remove the old wound bandages and old packing strips and put them into the plastic bag. (If it’s painful to pull out or feels stuck, pour some sterile wetting solution onto it to help the strip come out. Wounds are already sensitive so expect some discomfort.)
  7. Wash your hands again before proceeding to pack the wound.
  8. Put your sterile gloves on and squeeze the extra wetting solution from the packing strip so that it does not drip.
  9. Place the packing strip into the wound so that the space is occupied but not tightly filled.
  10. Use cotton swabs to gently push wound packing material into all areas of the wound. (I’m not going to lie, it’s not a painless process, as most wounds are already sensitive, but it is definitely worth the pain to avoid secondary infections or reoccurring abscesses from premature wound closure.)
  11. After packing the wound, place new dressing over the wound and tape it in place.
  12. After removing your gloves, wash your hands once again.

Concerns

Knowing how to pack wounds can significantly reduce the chance of infection, but wounds may become infected under even the most sterile conditions. See your doctor as soon as possible if you notice:

  • Wound tissue changing from pink to yellow, white, or very dark red in color
  • Increased seepage draining from the wound
  • Redness, swelling, or soreness around the wound
  • Foul odors coming from the wound
  • Enlargement of the wound

Deep wound infections can cause fever and chills if an infection has entered the bloodstream. Doctors prescribe antibiotics to treat most bacterial wound infections. If an infected wound fails to respond to antibiotics, drainage from the wound may be tested to determine the exact cause of the infection.

I know that with Hidradenitis Suppurativa, this is vital information and figured I’d share it with you guys, seeing as how we are required to continuously drain and pack many of our sites. I hope that this has been helpful in some way.


[1] [source: http://aast.org/discharge-instructions-for-wound-cares ]

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