Management of Leg Abscesses After Incision and Drainage

Primary Wound Management Approach

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

No packing with external absorbent dressing only is recommended, keeping the wound clean and dry initially, then beginning warm water soaks 24-48 hours after the procedure to promote drainage and healing 2
The loop drain technique, placing a catheter or drain into the abscess cavity that drains into an external dressing, is a minimally invasive approach that eliminates the need for repetitive painful packing changes 4, 3

The patient should keep the wound clean and dry for the first 24-48 hours, then begin warm water soaks or sitz baths at 24-48 hours post-procedure 2, 3
The external dressing should be changed regularly as it becomes saturated 2

Simple leg abscesses after adequate drainage do not require antibiotics, according to the 2018 WSES guidelines 1, 2
Antibiotics are indicated in cases of fever >38.5°C (101.3°F), diabetes or immunosuppression, surrounding cellulitis with systemic inflammatory response, or signs of organ failure (hypotension, oliguria, decreased mental alertness) 2, 3, 1

Fever >38.5°C (101.3°F), rapidly spreading redness around the wound, increasing pain, swelling, or pus after initial improvement are warning signs requiring immediate return 2
High recurrence rates (15-44%) emphasize that adequate initial drainage is critical, with risk factors for recurrence including inadequate initial drainage, loculations not adequately broken up, and premature skin closure preventing drainage from inside out 2, 3

Pain should progressively improve over the first week, with larger or deeper abscesses taking longer to heal completely 2
Avoiding strenuous activity for 48-72 hours is recommended to prevent bleeding or wound disruption 2

The World Society of Emergency Surgery (WSES) recommends placing a catheter or drainage in the abscess cavity that drains to an external dressing, leaving it in place until drainage ceases, as a minimally invasive technique 5
The use of hydrogel dressings of glycerin can be used as an alternative to traditional aseptic care during the first week, with evidence of significant reduction in infection scores 6, 7
Hydrogel dressings provide a moist environment that favors re-epithelialization and improves wound healing, and can be changed weekly, making them a cost-effective alternative 6, 7

Avoid occlusive dressings that promote an excessively humid environment and can cause skin maceration 6, 7

Monitor the drainage site daily for signs of bleeding, pain, erythema, induration, leakage, and inflammation 6, 7
Clean the site with 0.9% saline solution, sterile water, or cooled boiled water 6, 7
Consider using hydrogel dressing of glycerin if available, changing it weekly 6, 7

A Cochrane review found that it is unclear whether packing influences healing time, wound pain, fistula development, or abscess recurrence 5
A multicenter observational study of 141 patients concluded that packing is costly, painful, and does not add benefit to the healing process 5