Is Routine Irrigation of a Cutaneous Abscess Necessary?
Date First Published:
October 16, 2017
Last Updated:
October 16, 2017
Report by:
Joshua Badour MD; Matt Singh MD, Senior Emergency Medicine Resident (Spectrum Health/ Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey Jones MD, Spectrum Health/ Michigan State University Emergency Medicine Residency Program
Three-Part Question:
In an [adult patient with a cutaneous abscess] does [irrigation during incision and drainage], compared to [no irrigation], improve [wound outcomes]?
Clinical Scenario:
A 41 year old male presented to the emergency department with a 48 hour history of increasing erythema, swelling, and pain over his left lateral thigh. On examination you note a 4 cm area of erythema with associated fluctuance and induration. The decision is made to perform an incision and drainage, and you wonder whether irrigation of the abscess cavity would improve patient’s outcome.
Search Strategy:
Medline 1966-09/17 using PubMed, Cochrane Library, and Embase [(exp abscess/therapy) AND (exp irrigation)]. Limit to human, English language.
Search Details:
[(exp abscess/therapy) AND (exp irrigation)]. Limit to human, English language.
Outcome:
115 studies were identified using the above criteria. Of those studies there was one prospective study that directly addressed the clinical questions.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Irrigation of cutaneous abscesses does not improve treatment success Chinnock B, Hendey GW Mar-16 United States | 187 of 209 patients >18 years old randomized to irrigation vs nonirrigation | Unblinded RCT | Need for further intervention (antibiotics) in the subsequent 30 days | No difference (15% vs 13%) between the two groups in requiring further intervention | Unblinded; 11% loss to follow-up; significant imbalances between groups in terms of packing and antibiotic use; enrollment was not consecutive |
Author Commentary:
Although cutaneous abscesses are a common chief complaint to emergency departments throughout the world there are very few studies testing the efficacy of irrigating the abscess cavity. Despite this lack of evidence, irrigation has become a standard as part of the incision and drainage procedure. Potential disadvantages of irrigation include increased pain, procedural time, cost, and risk of concomitant infection. We could not identify any papers describing a benefit to irrigating an abscess versus not irrigating. This single randomized controlled trial, however, demonstrated no outcome benefit at 30 days when comparing irrigation and non-irrigation groups.
Bottom Line:
In adult patients with cutaneous abscesses routine irrigation during incision and drainage does not improve clinical outcomes.
References:
- Chinnock B, Hendey GW. Irrigation of cutaneous abscesses does not improve treatment success