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Is Routine Irrigation of a Cutaneous Abscess Necessary?

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 patientís outcome.

Search Strategy

Medline 1966-09/17 using PubMed, Cochrane Library, and Embase [(exp abscess/therapy) AND (exp irrigation)]. Limit to human, English language.
[(exp abscess/therapy) AND (exp irrigation)]. Limit to human, English language.

Search 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)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Chinnock B, Hendey GW
March 2016
United States
187 of 209 patients >18 years old randomized to irrigation vs nonirrigationUnblinded RCTNeed for further intervention (antibiotics) in the subsequent 30 daysNo difference (15% vs 13%) between the two groups in requiring further interventionUnblinded; 11% loss to follow-up; significant imbalances between groups in terms of packing and antibiotic use; enrollment was not consecutive

Comment(s)

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.

Clinical Bottom Line

In adult patients with cutaneous abscesses routine irrigation during incision and drainage does not improve clinical outcomes.

References

  1. Chinnock B, Hendey GW Irrigation of cutaneous abscesses does not improve treatment success Ann Emerg Med 2016; 67: 379-83.