Management of Abscess Wounds After Drainage

Wound Care Recommendations

The World Society of Emergency Surgery (WSES) recommends leaving the wound open to heal by secondary intention after abscess drainage, without routine cavity packing 1, 2.
The standard practice is to allow the wound to heal by secondary intention with regular dressing changes, as stated in the WSES-AAST 2021 guidelines 1, 2.
Regular dressing changes should be performed until the cavity heals completely, according to the WSES-AAST 2021 guidelines 1, 2.

The WSES does not recommend routine cavity packing after abscess drainage, based on recent evidence 1, 3, 4.
A multicenter observational study of 141 patients found that packing is costly, painful, and does not add benefit to the healing process 1, 3, 4.
The WSES-AAST 2021 guidelines state that no recommendation can be made on the use of packing after abscess drainage, based on available literature 1.

Some authors suggest placing a catheter or drain in the abscess cavity, allowing it to drain into an external dressing, until it stops draining 1, 4, 5.
This technique can be performed with a small incision under local anesthesia 1, 5.

Perianal and ischiorectal abscesses should be drained through the overlying skin 1.
Intersphincteric abscesses should be drained into the rectal lumen 1.
Supralevator abscesses require drainage into the rectal lumen (if an extension of an intersphincteric abscess) or externally through the skin (if an extension of an ischiorectal abscess) 1.

Routine cavity packing should be avoided, as it increases pain and costs without proven benefit 1, 3, 4.
Inadequate drainage should be avoided, ensuring complete evacuation of all purulent material 2.
Probing for fistulas in anorectal abscesses without obvious fistula should be avoided to prevent iatrogenic complications 3, 4, 6.