Why does dressing removal hurt so much?

Written by WISH Clinic

Clinically reviewed by Dr. Traci A. Kimball, MD, MBA

Last medical review

A wet-to-dry dressing is designed to dry onto the wound and lift dead tissue away, so the pain is part of how it works. Wet a sticking dressing to loosen it, unless your provider told you to pull it off dry.

With one widely used dressing, sticking is the point. In a wet-to-dry dressing, a wet (or moist) gauze dressing is put on your wound and allowed to dry. Wound drainage and dead tissue can then be removed when you take off the old dressing.

The same process is one of the ways wound care centers remove dead tissue. A wet dressing is applied to the wound and allowed to dry. As it dries, it absorbs some of the dead tissue. The dressing may be left dry or made wet again and then gently pulled off along with the dead tissue. Put more plainly: when the dressing is removed, some of the tissue comes off with it.

So if your dressing is wet-to-dry, it is doing the thing that makes it hurt. That does not mean every painful dressing change is fine, but it does mean the pain can be a feature of the dressing rather than a sign that the wound has gotten worse.

There are two instructions on what to do when a dressing sticks, and they are not the same. For a wet-to-dry dressing: if it is sticking to your skin, wet it with warm water to loosen it. For an open surgical wound: if the dressing sticks to the wound, wet it and try again, unless your provider instructed you to pull it off dry. That exception matters, because wetting a dressing you were told to remove dry would defeat its purpose. If you do not know which applies to you, ask before the next change rather than guessing.

Two other things are worth holding on to. The amount of packing is expected to fall as you improve: as the wound heals, you should not need as much gauze or packing gauze. And pain management is one of the kinds of help a wound care team provides. If dressing changes are the worst part of your week, that is something to say out loud at the next visit.

What to watch for

If you have a wet-to-dry dressing, contact your provider for worsening redness, more pain, swelling or bleeding, if the wound is larger or deeper, if it looks dried out or dark, if the drainage is increasing or has a bad smell, or if your temperature is 100.5°F (38°C) or higher for more than 4 hours.

For dressing-change pain specifically, note whether the pain is only during removal or carries on afterwards, whether the dressing comes away with tissue on it, and whether there is fresh bleeding every time. The wound should not bleed much while you clean it, and a small amount of blood is OK — more than that is worth mentioning. And settle the wet-or-dry question before the next change.

What we look at

  • Which dressing type is in use, and whether wet-to-dry is still the right choice
  • Whether the patient was instructed to remove it dry on purpose
  • Whether pain relief before a dressing change has been discussed
  • Whether the amount of packing can be reduced as the wound fills in
  • Whether gauze is sitting on intact skin around the wound rather than only in it

Related questions

Sources

  1. MedlinePlus — Wet-to-dry dressing changes: https://medlineplus.gov/ency/patientinstructions/000315.htm
  2. MedlinePlus — Surgical wound care, open: https://medlineplus.gov/ency/patientinstructions/000040.htm
  3. MedlinePlus — Wound care centers: https://medlineplus.gov/ency/patientinstructions/000739.htm
  4. MedlinePlus — Diabetes, foot ulcers: https://medlineplus.gov/ency/patientinstructions/000077.htm
Non-healing wound care at The WISH Clinic

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