What are the discharge instructions for a patient who underwent incision and drainage (I&D) of an abscess or cyst without packing in an urgent care setting?

Discharge Instructions After I&D of Abscess or Cyst Without Packing

After incision and drainage (I&D) of an abscess or cyst without packing, patients should be instructed to allow the wound to heal by secondary intention with regular cleaning but no routine packing is required. 1

Wound Care Instructions

• Cleaning: Clean the wound 2-3 times daily with warm water or saline
• Bathing: Take sitz baths (sitting in warm water) for 10-15 minutes several times daily to promote comfort and healing
• Dressing: Apply non-adherent absorbent dressings after cleaning
  • For deeper wounds, consider alginate or hydrofiber dressings
  • Change dressing when soiled or at least daily
• No packing needed: Current guidelines indicate no routine requirement for wound packing 1

Pain Management

• Take prescribed pain medications as directed
• Over-the-counter pain relievers (acetaminophen or ibuprofen) may be used as needed
• Sitz baths can help reduce pain and promote comfort
• Pain should gradually decrease over the first few days
• Research shows that non-packed wounds are significantly less painful than packed wounds 2

Follow-up Instructions

• First follow-up appointment within 48-72 hours after the procedure
• Subsequent follow-ups every 1-2 weeks until complete healing 3
• More frequent wound assessment (every 1-2 days) for patients with higher risk of delayed healing, such as those with inflammatory bowel disease or diabetes 3

Warning Signs (When to Seek Medical Attention)

• Increasing pain, redness, swelling, or warmth around the wound
• Fever over 100.4°F (38°C)
• Foul-smelling or increased drainage from the wound
• Bleeding that doesn't stop with gentle pressure
• Development of new areas of redness or hardness
• Signs of systemic illness (high fever, chills, vomiting)

Antibiotic Information

• If antibiotics were prescribed:
  • Take the full course as directed, even if symptoms improve
  • For immunocompetent patients with adequate drainage, a 4-day course is typically sufficient 3
  • For immunocompromised patients, antibiotics may be needed for up to 7 days 3
• Note that antibiotics are not routinely required for uncomplicated cases with adequate drainage 3, 4

Return to Activities

• Most patients can return to daily activities within 5-10 days 3
• Avoid strenuous activities or heavy lifting until the wound has substantially healed
• Avoid swimming or soaking in public pools/hot tubs until the wound is closed

Expected Healing Process

• The wound will heal from the bottom up (secondary intention)
• Complete healing typically takes 2-4 weeks depending on the size and location
• Studies show median healing times of 19.5-21 days for non-packed wounds 5
• Some drainage is normal for the first few days

Special Considerations

• If a seton was placed (for fistula treatment), it should remain in place for 1-2 months until resolution of induration and suppuration 3
• For perianal abscesses, monitor for signs of fistula formation, which occurs in 30-40% of cases 3

This approach to post-I&D care without packing is supported by multiple studies showing no difference in healing times, recurrence rates, or need for additional interventions compared to packed wounds, while resulting in significantly less pain 5, 2.