should we pack an abscess after I&D?

ABSCESS PACKING DATA:

--very limited, based on Pubmed biopsy


REVIEW ARTICLE:
--referenced one small article, and that was it


ONE SMALL ARTICLE:
--"determine whether the routine packing of simple cutaneous abscesses after incision and drainage (I&D) confers any benefit over I&D alone"
--prospective, randomized, single-blinded trial, N =48

• no significant difference in need for a second intervention at the 48-hour follow-up between the packed (4 of 23 subjects) and nonpacked (5 of 25 subjects) groups (p = 0.72; relative risk = 1.3, 95% confidence interval [CI] = 0.4 to 4.2)
• higher pain scores immediately postprocedure in packed group and at 48 hours postprocedure
• greater use of ibuprofen and oxycodone/acetaminophen in packed group 

ABOUT PERIANAL ABSCESSES:
--"designed to show that perianal abscess may be safely treated by incision and drainage alone" vs. I&D + packing
--50 patients were recruited (7 lost to follow-up); 20 in the packing and 23 in the nonpacking arm

• Mean healing times were similar ( P = 0.214).
• The rate of abscess recurrence was similar ( P = 0.61).
• Postoperative fistula rates were similar ( P = 0.38).
• Pain scores at the first dressing change were similar ( P = 0.296).
• Although pain scores appeared much reduced in the nonpacking arm, this did not attain statistical significance

BOTTOM LINE:
--limited data out there on packing abscesses
--packing doesn't seem to improve healing or reduce recurrence
--packing might hurt more
--probably ok to NOT pack abscess after I&D


Submitted by S. Lee.


Reference(s): review article, one small article, perianal abscess article, picture