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abscesses; to pack or not to pack

Three Part Question

In [a patient with an abscess] does [packing the wound or not packing the wound] [affect healing time]?

Clinical Scenario

A 32 year old man attends casualty with a large abscess on his bottom, painful and ready to burst. You wonder whether you should pack the abscess after draining it. He is self-employed and needs to get back to work quickly.

Search Strategy

Medline using the OVID interface 1966-
Embase using the OVID interface 1980-
([exp abscess/ OR exp furunculosis/ OR OR exp carbuncle/] AND [exp wound healing/ OR OR OR]

Search Outcome

8 papers were identified, 2 of which could not be obtained and one of which turned out to be irrelevant

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Stewart et al
137 surgical outpatients 64 sutured (4 had a drain as abscess was >8cm) - 73 packedRCTMean time to healingSutured group 7 days. Packed group 25 days.Not blinded Consultant care
Mean time off workSutured group 4 days. Packed group 14 days.
Barnes and Milsom
1943 accident and emergency outpatientsReviewTime to wound healingSutured group (n=891) 6.5-21 days. Packed group (n=301) 7.8-35 days.
Recurrence rateSutured group (n=612) 6.6-22%. Packed group (n=139) 13.5-33%
Abrahams et al
61 surgical inpatients 32 treated by drainage and suture - 29 treated with drainage and packedPRCTHealing rate Suture group 78% better within 1 week. Packed group 3% better.Not blinded Consultant treatment
Healing rate at one monthSutured group 88% better 1 month with better scar and less pain. Packed group 90% better.
Simms et al
114 accident and emergency out-patientsPRCTMean time to healing54 patients sutured 8.9 days. 60 patients packed 7.8 days.Not blind Small trial Use of single dose clindamycin
Sorensen et al
60 Surgical outpatients 10 excluded due to the presence of a fistula or abscess cavity >10 cmRandomised TrialMean time to healingSutured group (n=25) 9 days. Packed group (n=25) 15 days.Small numbers Consultant care Single dose ceftazidime given


There is evidence that packing abscesses may delay healing, does not improve outcome, delays return to work, increases pain, results in a worse scar and is more expensive in nursing time and dressings

Editor Comment

This search has been repeated by the editorial team and a number of other citations have been found. We have attempted to contact the original author but as yet have had no reply.

Clinical Bottom Line

Don't pack abscesses, ever!


  1. Stewart MP. Laing MR. Krukowski ZH. Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial. British Journal of Surgery. 72(1):66-7, 1985 Jan.
  2. Barnes SM. Milsom PL. Abscesses: an open and shut case. Archives of Emergency Medicine. 5(4):200-5, 1988 Dec.
  3. Abraham N. Double M. Carson P. Open versus closed surgical treatment of abscesses: A controlled clinical trial. Australian & New Zealand Journal of Surgery. Vol. 67(4)(pp 173-176), 1997.
  4. Simms MH. Curran F. Johnson RA. Oates J. Givel JC. Chabloz R. ALexander-Williams J. Treatment of acute abscesses in the casualty department. British Medical Journal Clinical Research Ed. 284(6332):1827-9, 1982 Jun 19.
  5. Sorensen C. Hjortrup A. Moesgaard F. Lykkegaard-Nielsen M. Linear incision and curettage vs. deroofing and drainage in subcutaneous abscess. A randomized clinical trial. Acta Chirurgica Scandinavica. 153(11-12):659-60, 1987 Nov-Dec.