From the Guidelines
Abscess flushing should be performed after incision and drainage to remove purulent material and debris from the abscess cavity, as recommended by the Infectious Diseases Society of America 1.
Procedure
To perform abscess flushing, begin by using sterile normal saline solution (0.9% sodium chloride) in a syringe to gently irrigate the cavity. The volume needed depends on the abscess size, but continue until the fluid returning is clear. Use a 19-gauge needle or catheter attached to a 20-60 mL syringe for effective irrigation.
Post-Flushing Care
After flushing, leave the wound open with packing material (such as iodoform gauze) to allow continued drainage, changing the packing every 24-48 hours until the cavity begins to heal from the bottom up.
Antibiotic Therapy
Antibiotics may be necessary depending on the severity, location, and patient factors, with common choices including trimethoprim-sulfamethoxazole (Bactrim DS 1-2 tablets twice daily for 7-10 days) or clindamycin (300-450 mg orally four times daily for 7-10 days) to cover MRSA, as suggested by the guidelines 1.
Rationale
Flushing is crucial because it physically removes bacteria, inflammatory cells, and necrotic tissue that could impede healing and lead to recurrence, while also breaking up loculations that might harbor infection. Some key points to consider when managing abscesses include:
- Incision and drainage is the primary treatment for cutaneous abscesses 1
- Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, rapid progression, or signs of systemic illness 1
- Empirical therapy for CA-MRSA is recommended pending culture results for outpatients with purulent cellulitis 1
From the Research
Abscess Flushing
- Abscess flushing, also known as abscess irrigation, is a procedure that involves flushing out the purulent material from an abscess with a saline solution after incision and drainage 2, 3.
- The goal of abscess flushing is to remove any remaining bacteria, debris, and inflammatory tissue from the abscess cavity, promoting healing and reducing the risk of recurrence.
- However, there is limited evidence to support the routine use of abscess flushing in the management of simple abscesses 4, 5.
- Some studies suggest that packing wounds larger than 5 cm may reduce recurrence and complications, but the role of abscess flushing in this context is unclear 2.
- The use of antibiotics after incision and drainage of simple abscesses is also a topic of debate, with some studies suggesting that systemic antibiotics do not significantly improve outcomes 4, 6.
- In general, the management of abscesses should be individualized based on the size, location, and type of abscess, as well as the patient's overall health status and risk factors 3, 5.
Key Considerations
- Incision and drainage is the primary treatment for most simple abscesses 2, 3.
- The use of ultrasound can be valuable in diagnosing abscesses and guiding incision and drainage procedures 3.
- Antibiotics may be necessary in certain cases, such as in patients with underlying medical conditions or in cases of complex abscesses 6, 5.
- Further research is needed to determine the optimal management strategies for abscesses, including the role of abscess flushing and antibiotic therapy 4, 5.