Three Part Question
In [a patient with an abscess] does [packing the wound or not packing the wound] [affect healing time]?
A 32 year old man attends casualty with a large abscess on his bottom, painful and ready to burst. You wonder whether you should pack the abscess after draining it. He is self-employed and needs to get back to work quickly.
Medline using the OVID interface 1966-
Embase using the OVID interface 1980-
([exp abscess/ OR exp furunculosis/ OR furuncle.mp. OR exp carbuncle/] AND [exp wound healing/ OR wick.mp. OR drain.mp. OR recover.mp.]
8 papers were identified, 2 of which could not be obtained and one of which turned out to be irrelevant
|Author, date and country
||Study type (level of evidence)
|Stewart et al|
|137 surgical outpatients
64 sutured (4 had a drain as abscess was >8cm) - 73 packed||RCT||Mean time to healing||Sutured group 7 days. Packed group 25 days.||Not blinded
|Mean time off work||Sutured group 4 days. Packed group 14 days.|
|Barnes and Milsom|
|1943 accident and emergency outpatients||Review||Time to wound healing||Sutured group (n=891) 6.5-21 days. Packed group (n=301) 7.8-35 days.|
|Recurrence rate||Sutured group (n=612) 6.6-22%. Packed group (n=139) 13.5-33%|
|Abrahams et al|
|61 surgical inpatients
32 treated by drainage and suture - 29 treated with drainage and packed||PRCT||Healing rate ||Suture group 78% better within 1 week. Packed group 3% better.||Not blinded
|Healing rate at one month||Sutured group 88% better 1 month with better scar and less pain. Packed group 90% better.|
|Simms et al|
|114 accident and emergency out-patients||PRCT||Mean time to healing||54 patients sutured 8.9 days. 60 patients packed 7.8 days.||Not blind
Use of single dose clindamycin|
|Sorensen et al|
|60 Surgical outpatients
10 excluded due to the presence of a fistula or abscess cavity >10 cm||Randomised Trial||Mean time to healing||Sutured group (n=25) 9 days. Packed group (n=25) 15 days.||Small numbers
Single dose ceftazidime given|
There is evidence that packing abscesses may delay healing, does not improve outcome, delays return to work, increases pain, results in a worse scar and is more expensive in nursing time and dressings
This search has been repeated by the editorial team and a number of other citations have been found. We have attempted to contact the original author but as yet have had no reply.
Clinical Bottom Line
Don't pack abscesses, ever!
- Stewart MP. Laing MR. Krukowski ZH. Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial. British Journal of Surgery. 72(1):66-7, 1985 Jan.
- Barnes SM. Milsom PL. Abscesses: an open and shut case. Archives of Emergency Medicine. 5(4):200-5, 1988 Dec.
- Abraham N. Double M. Carson P. Open versus closed surgical treatment of abscesses: A controlled clinical trial. Australian & New Zealand Journal of Surgery. Vol. 67(4)(pp 173-176), 1997.
- Simms MH. Curran F. Johnson RA. Oates J. Givel JC. Chabloz R. ALexander-Williams J. Treatment of acute abscesses in the casualty department. British Medical Journal Clinical Research Ed. 284(6332):1827-9, 1982 Jun 19.
- Sorensen C. Hjortrup A. Moesgaard F. Lykkegaard-Nielsen M. Linear incision and curettage vs. deroofing and drainage in subcutaneous abscess. A randomized clinical trial. Acta Chirurgica Scandinavica. 153(11-12):659-60, 1987 Nov-Dec.