Version May 2024
| Preparation |
| 1. Explain the procedure to the patient and/or caretaker and obtain informed consent. |
| 2. Provide prophylaxis for bacterial endocarditis, if indicated. |
| 3. Provide procedural sedation and analgesia in addition to local anesthesia. |
| Incision and drainage |
| 1. Identify the area of maximal fluctuance. |
| 2. Using a scalpel with either an 11 or 15 blade, make a simple linear incision at the point of maximal fluctuance and through the length of the abscess; a stab incision may be used in a cosmetic area. |
| 3. Obtain culture of drainage fluid, if indicated*. |
| 4. Bluntly probe the abscess cavity with a curved hemostat to remove any identified foreign body and to break up loculations. |
| 5. Copiously irrigate the abscess cavity with normal saline until all visible pus is removed. |
| 6. Pack large abscesses (>5 cm in diameter) and pilonidal abscesses with sterile packing gauze or iodoform. Some physicians may choose to pack all abscesses that will accept packing strips. |
| 7. We suggest that abscesses be left open to heal by secondary intention. |
| 8. Provide antibiotic therapy to selected patients¶. |
| 9. Provide tetanus prophylaxis, as indicated. |
| Follow-up |
| 1. Schedule the patient for a wound check within 24 to 48 hours. |
| 2. At the follow-up visit, remove packing (if present) in patients whose drainage has stopped and initiate warm wet soaks (mild saline solution or soapy water). |
| 3. If drainage persists at the follow-up visit, remove the old packing material and repack with new packing strips. Continue evaluation every 24 to 48 hours with repacking until the drainage stops. |
| 4. If the patient underwent primary closure, remove sutures if pus has reaccumulated. Otherwise, instruct the patient to keep the wound clean and arrange for suture removal seven days after initial incision and drainage. |
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