What is the recommended dressing for an abscess on the leg after incision and drainage (I&D)?

Best Dressing After I&D for Leg Abscess

For simple leg abscesses after incision and drainage, do not use packing—instead allow the wound to heal by secondary intention with warm water soaks starting 24-48 hours post-procedure, or consider placing a simple loop drain or catheter that drains into an external dressing. 1, 2

Primary Wound Management Approach

The evidence strongly supports avoiding traditional packing for simple abscesses. 1, 2 The 2018 WSES/SIS-E consensus guidelines emphasize that incision and drainage is the primary treatment for simple abscesses, and packing provides no proven benefit while causing additional pain and healthcare costs without improving healing time or reducing recurrence rates. 3, 2

Recommended Dressing Options (in order of preference):

• No packing with external absorbent dressing only: Keep the wound clean and dry initially, then begin warm water soaks 24-48 hours after the procedure to promote drainage and healing 1

  • Allow the wound to heal from inside out (secondary intention)—do not allow skin edges to close prematurely 1
  • Apply a simple absorbent external dressing that is changed regularly 1

• Loop drain technique: Place a catheter or drain into the abscess cavity that drains into an external dressing, left in place until drainage stops 3, 2, 4, 5

  • This minimally invasive approach eliminates need for repetitive painful packing changes 4, 5
  • The drain typically remains for 10-11 days on average 5
  • Particularly effective for larger abscesses (>5 cm) 6

• If packing is used (only for wounds >5 cm where evidence suggests potential benefit): Remove within 24 hours 1, 6

  • One study showed silver-containing hydrofiber dressing (Aquacel Ag) was superior to iodoform for faster healing and less pain 7
  • However, the guideline consensus remains that packing should generally be avoided 1, 2

Critical Post-Procedure Instructions

Wound Care Protocol:

• Keep wound clean and dry for first 24-48 hours 1
• Begin warm water soaks or sitz baths at 24-48 hours post-procedure 1, 2
• Change external dressing regularly as it becomes saturated 1

When Antibiotics Are NOT Needed:

• Simple leg abscesses after adequate drainage do not require antibiotics 3, 1
• The 2018 WSES guidelines explicitly recommend NOT using antibiotics for simple abscesses or boils after adequate drainage 3

When Antibiotics ARE Indicated:

• Fever >38.5°C (101.3°F) 1, 2
• Diabetes or immunosuppression 1, 2
• Surrounding cellulitis with systemic inflammatory response 3, 1
• Signs of organ failure (hypotension, oliguria, decreased mental alertness) 3

Warning Signs Requiring Immediate Return:

• Fever >38.5°C (101.3°F) 1
• Rapidly spreading redness around the wound 1
• Increasing pain, swelling, or pus after initial improvement 1

Common Pitfalls to Avoid:

High recurrence rates (15-44%) emphasize that adequate initial drainage is critical. 1, 2 Risk factors for recurrence include:

• Inadequate initial drainage 2
• Loculations not adequately broken up 2
• Premature skin closure preventing drainage from inside out 1

Do not routinely pack wounds as this causes unnecessary pain during changes, increases healthcare costs, and provides no benefit for healing time, fistula development, or abscess recurrence. 3, 2 A Cochrane review and subsequent multi-center study confirmed packing is costly, painful, and adds no benefit. 3

Expected Healing Timeline:

• Pain should progressively improve over the first week 1
• Larger or deeper abscesses may take longer to heal completely 1
• If loop drain used, expect removal around 10 days when drainage stops 5
• Avoid strenuous activity for 48-72 hours to prevent bleeding or wound disruption 1