Post-Operative Care for Drained Wound Abscesses
The most important treatment for a wound abscess is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention, with antibiotics only necessary in specific circumstances such as sepsis, surrounding soft tissue infection, or immune compromise. 1
Immediate Post-Drainage Care
- Complete evacuation of the abscess is critical as inadequate drainage is a major risk factor for recurrence, which can be as high as 44% 1
- The wound should be left open to heal by secondary intention after drainage to prevent premature closure and recurrence 1, 2
- Hemostasis should be achieved before applying any dressing 2
Wound Packing Considerations
- Current evidence does not clearly support routine packing of abscess cavities after drainage 1
- A Cochrane review found insufficient evidence that packing influences healing time, wound pain, fistula development, or abscess recurrence 1, 2
- Packing may cause increased pain during dressing changes and adds healthcare costs without clear benefit to healing 1, 2, 3
- For larger wounds (>5 cm), some evidence suggests packing may reduce recurrence and complications, though data is limited 4
Dressing Management
- If packing is used based on clinician judgment, it should be changed regularly until the cavity heals 2
- Some clinicians alternatively place a catheter or drain into the abscess cavity with a small stab incision under local anesthetic, leaving it in place until drainage stops 1, 2
- For non-packed wounds, regular dressing changes with assessment for proper healing and drainage is recommended 1, 2
Antibiotic Therapy
- Antibiotics are generally unnecessary for drained abscesses in immunocompetent patients without systemic signs of infection 1, 5
- Antibiotic administration is recommended only in the following circumstances:
Follow-up Care
- Regular wound assessment for signs of proper healing or complications 1
- Warm soaks can be beneficial for wound healing 5
- Pain management should be provided as needed 5
- For anorectal abscesses specifically, close monitoring for fistula development is important, as approximately one-third may develop fistula-in-ano 1
Special Considerations for Anorectal Abscesses
- If a fistula is identified during drainage of an anorectal abscess:
- For low fistulas not involving sphincter muscle, fistulotomy may be performed at the time of drainage 1
- For fistulas involving sphincter muscle, place a loose draining seton rather than performing immediate fistulotomy 1
- Avoid probing to search for a fistula if one is not obvious, as this may cause iatrogenic complications 1
Monitoring for Complications
- Watch for signs of inadequate drainage, including persistent pain, swelling, or fever 1
- Monitor for recurrence, which is more common with horseshoe-type abscesses, loculations, or delayed initial drainage 1
- For patients with systemic signs of infection, monitor inflammatory markers (e.g., C-reactive protein, procalcitonin) 1
Clinical Pitfalls to Avoid
- Premature closure of the skin before complete drainage and healing of the deeper tissues 1, 2
- Inadequate initial drainage leading to recurrence 1
- Unnecessary use of antibiotics in simple drained abscesses 1, 3
- Probing for fistulas in anorectal abscesses, which can create iatrogenic complications 1
- Failure to identify and appropriately manage high-risk patients who may need more aggressive care (immunocompromised, diabetic) 1