From the Guidelines
If you have a draining incision, the most important step is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention, as this is the most effective therapy for a surgical site infection (SSI) 1. When managing a draining incision, it's crucial to prioritize proper wound care to prevent complications and promote healing.
- Clean the incision gently with mild soap and water, then pat it dry with a clean towel.
- Cover the area with a sterile dressing or bandage, changing it whenever it becomes wet or soiled, typically 1-3 times daily.
- Monitor the drainage - clear or slightly bloody discharge is normal initially, but thick, yellow, green, or foul-smelling drainage suggests infection.
- Watch for signs of infection, such as increasing redness, warmth, swelling, worsening pain, fever above 100.4°F (38°C), or red streaks extending from the wound, which require prompt medical attention. According to the Infectious Diseases Society of America, adjunctive systemic antimicrobial therapy may be beneficial for SSIs associated with a significant systemic response, such as erythema and induration extending >5 cm from the wound edge, temperature >38.5°C, heart rate >110 beats/minute, or white blood cell (WBC) count >12 000/µL 1.
- Take any prescribed antibiotics exactly as directed, completing the full course even if symptoms improve.
- Avoid submerging the incision in water (baths, pools, hot tubs) until your doctor approves. It's essential to note that drainage occurs because your body is healing and removing excess fluid from the surgical site, but proper wound care is vital to prevent complications and promote healing.
- If drainage increases rather than decreases over time, contact your healthcare provider as this may indicate a problem with the healing process.
From the Research
Draining Incision Management
- A draining incision can be a sign of an underlying infection or abscess, and proper management is crucial to prevent further complications 2, 3.
- The primary treatment for a simple abscess is incision and drainage, which can be performed in an ambulatory office setting or emergency department 2, 4.
- Wound culture and antibiotics are not always necessary, but may be recommended in certain cases, such as if the infection spreads to surrounding tissue or if there is a lack of response to incision and drainage alone 2, 3.
Post-Operative Care
- Post-operative care for a draining incision includes warm soaks, drains or wicks, analgesia, and close follow-up 4.
- It is essential to make a surgically appropriate incision that allows adequate drainage without injuring important structures 4.
- Complications of incision and drainage can include damage to adjacent structures, bacteremic complications, and spread of infection due to inadequate drainage 4.
Use of Drains
- Drains can be used to remove body fluids and prevent the accumulation of serous fluid, promoting wound healing 5.
- Closed vacuum drains can apply negative suction in a sealed environment, producing apposition of tissues and thus promoting healing 5.
- Correct assessment of clinical indications is crucial to reduce unnecessary usage of drains 5.
Special Considerations
- Abscesses in specific locations, such as the face, palm, or genitalia, may require special consideration for diagnosis and treatment, and may require specialty consultation 3, 4.
- Bites and burn wounds require special attention, and antibiotic treatment should be started immediately in cases of hand and puncture wounds 3.