What is the best dressing for an abscess?

Best Dressing for Abscess

For most abscesses after incision and drainage, simply covering the wound with a dry dressing is the recommended approach, as wound packing has not been proven to improve healing and causes unnecessary pain and healthcare costs. 1

Evidence Against Routine Packing

The 2021 World Journal of Emergency Surgery guidelines explicitly state that no recommendation can be made regarding the use of packing after drainage of an anorectal abscess based on available literature. 1 The evidence reveals:

• A Cochrane review found it "unclear whether using internal dressings (packing) influences time to healing, wound pain, development of fistulae, or abscess recurrence" 1
• A multi-center observational study of 141 patients concluded that packing is costly and painful and does not add benefit to the healing process 1
• Packing causes significant pain during dressing changes without proven benefit for healing time or recurrence rates 2

When Packing May Be Considered

For wounds larger than 5 cm, packing may reduce recurrence and complications, though this remains controversial. 3 The traditional rationale for packing includes:

• Hemostasis immediately post-drainage 1
• Prevention of premature skin closure over an undrained cavity 1

Alternative Dressing Options

Silver-Containing Hydrofiber Dressing

If packing is deemed necessary, silver-containing hydrofiber dressing (Aquacel Ag) is superior to traditional iodoform packing, showing:

• Faster wound healing with >30% reduction in abscess surface area at first follow-up (p=0.002) 4
• Significant decrease in pain intensity compared to iodoform 4
• Better patient tolerance during dressing changes 4

High-Vacuum Drainage System

For pediatric patients or complex abscesses, high-vacuum wound drainage systems offer significant advantages over traditional packing:

• Significantly lower pain scores on FACES scale 5
• Shorter length of stay and fewer dressing changes required 5
• Zero recurrence rate compared to 10 recurrences in traditional I&D group 5
• Allows primary wound closure with drainage in place 5

Practical Algorithm

For simple cutaneous abscesses:

1. Perform thorough incision and drainage with cavity exploration to break up loculations 6
2. Cover with dry absorbent dressing 6
3. No packing required unless >5 cm 3

For large abscesses (>5 cm):

1. Consider silver-containing hydrofiber ribbon if packing is used 4
2. Multiple counter-incisions preferred over single long incision 6
3. Avoid traditional iodoform packing due to increased pain 4

For complex or pediatric abscesses:

1. Consider high-vacuum drainage system with primary closure 5
2. Reduces need for painful dressing changes 5

Critical Pitfalls to Avoid

• Do not routinely pack all abscess cavities - this increases pain and cost without proven benefit 1, 2
• Avoid iodoform packing when alternatives exist - it causes more pain than antimicrobial hydrofiber dressings 4
• Do not use needle aspiration alone - it has only 25% success rate and <10% with MRSA infections 6
• Ensure complete drainage - inadequate drainage is a major risk factor for 44% recurrence rate 1

Special Considerations

Antibiotics are generally not needed after adequate drainage unless systemic signs of infection are present, the patient is immunocompromised, or significant surrounding cellulitis exists. 6 The focus should be on adequate surgical drainage rather than relying on dressings or packing to compensate for incomplete drainage. 1