• 
• 

Three Part Question

In [a patient with an abscess] does [packing the wound or not packing the wound] [affect healing time]?

Clinical Scenario

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.

Search Strategy

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.]

Search Outcome

8 papers were identified, 2 of which could not be obtained and one of which turned out to be irrelevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Stewart et al 1985 UK	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 Consultant care
			Mean time off work	Sutured group 4 days. Packed group 14 days.
Barnes and Milsom 1988 UK	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 1997 Australia	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 Consultant treatment
			Healing rate at one month	Sutured group 88% better 1 month with better scar and less pain. Packed group 90% better.
Simms et al 1982 UK	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 Small trial Use of single dose clindamycin
Sorensen et al Denmark 1987	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 Consultant care Single dose ceftazidime given

Comment(s)

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

Editor Comment

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!

References

1. 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.
2. Barnes SM. Milsom PL. Abscesses: an open and shut case. Archives of Emergency Medicine. 5(4):200-5, 1988 Dec.
3. 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.
4. 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.
5. 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.