Should You Steri-Strip an Incision After Abscess I&D?
No, you should not steri-strip or close an abscess incision after drainage—the wound must be allowed to heal by secondary intention (from the inside out) to prevent premature skin closure and abscess recurrence. 1
Primary Wound Management Principle
The fundamental principle in abscess management is to prevent the skin edges from closing prematurely, as this can trap residual infection and lead to recurrence rates as high as 44%. 1, 2
- The Infectious Diseases Society of America explicitly recommends allowing the wound to heal from the inside out (secondary intention) rather than closing the skin edges. 1
- Adequate drainage is the single most critical factor in preventing recurrence—inadequate initial drainage is the primary cause of treatment failure. 2
Evidence on Primary Closure
While some research has explored primary closure after I&D, this approach contradicts current guideline recommendations:
- A 2013 randomized trial found similar healing rates between primary and secondary closure (69.6% vs 59.3% at 7 days), but this study examined simple cutaneous abscesses and did not demonstrate superiority of closure. 3
- A systematic review showed primary closure resulted in faster healing time (7.8 vs 15.0 days), but these studies were predominantly from surgical settings with anogenital abscesses, not typical emergency department presentations. 4
- Despite these research findings, current guidelines prioritize preventing recurrence over faster healing time, recommending secondary intention healing. 1
Correct Post-Drainage Wound Care
- Keep the wound clean and dry initially for the first 24-48 hours. 1
- Begin warm water soaks or sitz baths 24-48 hours after the procedure to promote continued drainage and healing. 1
- If packing was placed, it should be removed within 24 hours—evidence shows packing does not improve healing time and causes additional pain. 1, 5
Common Pitfall to Avoid
The most critical error is allowing or causing premature skin closure (whether by steri-strips, sutures, or any other method), as this creates a closed space where bacteria can re-accumulate, leading to recurrence rates up to 44%. 1, 2