Quick Reference
Techniques
- Straight Incision
- Incision & Loop Drainage
- Field Block -> avoid injection of Local Anesthetic into abscess
Systemic Antibiotics
- No, unless:
- Febrile
- Diabetic / immunocompromised
- Patient is being admitted for systemic illness related to abscess
- Clinician preference
- Associated animal bite
Irrigation
- Only with loop technique
Packing
- Probably not, unless it’s a large cavity
- If packing, do it loosely
Cultures
- Yes, per IDSA 2014 SSTI guidelines, BUT
- In reality, only if concerning clinical presentation
- repeated abscesses not responding
- spooky HPI
Pain Control
- NSAIDs / APAP
Indications/ Contraindications
Indications
- Cutaneous abscess without adequate spontaneous drainage
Contraindications
- Consider surgery consult for:
- abscesses that track into musculature or fascia
- close proximity to vascular or nerve structures
- Certain anatomical locations may require specialist/surgical consult
- Perirectal abscess
- Periareolar/breast abscess
- Scrotal abscess
- Vulvar abscess
- Abscess over prior surgical site
- Extensive size of abscess causing systemic illness
Patient Education
Wound Care at Home
- Keep the wound clean and dry. Change the dressing at least once a day, or sooner if it becomes soaked with drainage.
- If your wound was packed with gauze: Follow up with a medical provider in 1–2 days to have the packing removed or changed. Do not remove the packing yourself unless your doctor told you to.
- If your wound was not packed: Simply keep a clean, dry bandage over the wound. Change it daily or when soiled.
- Gently wash the area with mild soap and water during dressing changes. Pat dry.
- Do not submerge the wound in a bath, pool, or hot tub until it is fully healed.
- It is normal for the wound to drain a small amount of blood-tinged or yellowish fluid for a few days.
References
IDSA 2014 Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections
Beyond the Knife: A Contemporary Review of Subcutaneous Abscesses - PubMed