Abscess incision and drainage

Last updated: June 9, 2023

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Summarytoggle arrow icon

Incision and drainage (I&D) is a procedure used to drain pus from skin and soft tissue abscesses; it can be performed in both adults and children. This article describes bedside I&D, which should not be performed for abscesses that warrant surgical consultation such as those located near important structures (e.g., nerves, arteries) or in areas of cosmetic concern (e.g., face, breast). During the procedure, an incision is made into the overlying tissue to facilitate pus drainage. Abscess irrigation and packing may be performed after I&D, however, there is limited evidence to support their use. Complications include damage to surrounding structures and abscess recurrence.

For specific considerations regarding abscesses of the Bartholin glands, see “Bartholin gland abscess.”

Indicationstoggle arrow icon

Do not perform I&D in the absence of fluctuance: Premature incision before abscess formation may cause extension of the infectious process. [3]

Contraindicationstoggle arrow icon

Most skin and soft tissue abscesses can be drained at the bedside, but the following findings may indicate the need for a surgical consult: [2][4]

We list the most important contraindications. The selection is not exhaustive.

Equipment checklisttoggle arrow icon

Incision and drainage

  • PPE (mask, gloves, eye shield)
  • Surgical drapes
  • Antiseptic solution
  • Local anesthetic (e.g., 1% lidocaine)
  • Syringe with 25-gauge needle
  • Scalpel with a No. 11 or No. 15 blade
  • Clamp (e.g., hemostat)
  • Gauze pads
  • Culture swab (if indicated)
  • Absorbent dressing

Abscess irrigation

  • Sterile normal saline
  • Syringe with needleless 18-gauge angiocatheter OR splash cap

Abscess packing

  • Ribbon gauze (e.g., ¼ inch, ½ inch)
  • Forceps
  • Scissors

Preparationtoggle arrow icon

Procedure/applicationtoggle arrow icon

This procedure can be performed in both adults and children.

Anesthesia [3]

Multiple anesthetic options are available for I&D; the method used depends on abscess characteristics (e.g., size, location) and physician and patient preferences.

Avoid injecting local anesthetic into the abscess cavity, as this can result in increased pain due to tissue distention or bacterial infiltration into healthy tissue.

Incision and drainage [2][3]

  1. Provide local or regional anesthesia.
  2. Make a linear incision across the length of the abscess with a scalpel.
  3. Allow pus to drain.
  4. Consider obtaining a sample for culture. [6][7][8]
  5. Perform blunt dissection of the abscess cavity using a clamp to break up loculations.
  6. Consider abscess irrigation.
  7. Consider abscess packing.
  8. Cover the incision with an absorbent dressing.

Irrigation and packing [2]

Both irrigation and packing are often described as part of the I&D procedure, however, evidence that these techniques improve outcomes is lacking. [9][10][11]

Abscess irrigation

  1. Irrigate the wound with sterile normal saline.
  2. Continue irrigation until the outflow runs clear.

Abscess packing

  1. Insert the end of the ribbon gauze into the cavity using forceps.
  2. Advance the ribbon gauze until the cavity is loosely packed.
  3. Leave a short tail of ribbon gauze outside the cavity.

Pitfalls and troubleshootingtoggle arrow icon

Postprocedure checklisttoggle arrow icon

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. $Contributor Disclosures - Abscess incision and drainage. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  2. Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Abscess Incision and Drainage. N Engl J Med. 2007; 357 (19): p.e20.doi: 10.1056/nejmvcm071319 . | Open in Read by QxMD
  3. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018
  4. Reichman EF. Reichman's Emergency Medicine Procedures, 3rd Edition. McGraw Hill Professional ; 2018
  5. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  6. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014; 59 (2): p.e10-52.doi: 10.1093/cid/ciu444 . | Open in Read by QxMD
  7. Ramakrishnan K, Salinas RC, Agudelo Higuita NI. Skin and Soft Tissue Infections. Am Fam Physician. 2015; 92 (6): p.474-83.
  8. Miller LG, Quan C, Shay A, et al. A Prospective Investigation of Outcomes after Hospital Discharge for Endemic, Community-Acquired Methicillin-Resistant and -Susceptible Staphylococcus aureus Skin Infection. Clinical Infectious Diseases. 2007; 44 (4): p.483-492.doi: 10.1086/511041 . | Open in Read by QxMD
  9. Chinnock B, Hendey GW. Irrigation of Cutaneous Abscesses Does Not Improve Treatment Success. Ann Emerg Med. 2016; 67 (3): p.379-383.doi: 10.1016/j.annemergmed.2015.08.007 . | Open in Read by QxMD
  10. O’Malley GF, Dominici P, Giraldo P, et al. Routine Packing of Simple Cutaneous Abscesses Is Painful and Probably Unnecessary. Academic Emergency Medicine. 2009; 16 (5): p.470-473.doi: 10.1111/j.1553-2712.2009.00409.x . | Open in Read by QxMD
  11. Kessler DO, Krantz A, Mojica M. Randomized Trial Comparing Wound Packing to No Wound Packing Following Incision and Drainage of Superficial Skin Abscesses in the Pediatric Emergency Department. Pediatr Emerg Care. 2012; 28 (6): p.514-517.doi: 10.1097/pec.0b013e3182587b20 . | Open in Read by QxMD

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