Abscess 

Drained by surgeon:
•	Abscess in any of the following locations:
o	Perirectal
o	Anterior and lateral neck
o	Hand abscess
o	Abscesses adjacent to vital nerves or blood vessels
o	Abscesses in central triangle of face
o	Breast abscesses
•	Recurrent or multiple abscesses need surgeon to address/assess for fistula
•	Patients who are not good candidates for procedural sedation

Emphasize the following important features of incision and drainage:
?	An abscess may be much larger than it appears on the surface. Thus, it may require a longer incision than the patient expects.
?	Scarring should be expected, including the possibility of keloid formation.
?	Recurrence is relatively common, particularly in patients with hidradenitis suppurativa or an infected sebaceous cyst.

Equipment:
?	Sterile gloves, drapes, and 4 x 4 inch gauze
?	Goggles or other eye protection (eg, surgical mask with integrated visor)
?	Povidone-iodine solution
?	Local anesthetic (eg, 1 or 2 percent lidocaine)
?	3 to 10 mL syringe and needle of 25, 27, or 30 gauge
?	Culture swab
?	Number 11 blade and scalpel holder 
?	Curved hemostats
?	Forceps
?	Scissors
?	Needleless 30 to 60 mL syringe with 19 gauge IV catheter or needleless irrigation device with splash protection (eg, Zerowet Splashield)
?	Basin with sterile saline solution
?	Packing material (eg, iodoform or plain gauze packing tape)
?	Dressing of choice

PACKING
After incision and drainage, we suggest packing any abscess cavity that meets any of the following criteria:
?	Abscess >5 cm in diameter
?	Pilonidal abscess
?	Abscess in an immunocompromised or diabetic patient


Closure
Available evidence is of low quality and does not indicate a clear benefit for primary closure of abscesses over healing by secondary intention. If sutures are placed, close wound follow-up must be assured to evaluate for reaccumulation of pus. Also, primary closure should be avoided in patients with the following conditions:
?	Immunocompromise (eg, diabetes mellitus, chronic immunosuppressive therapy, or human immunodeficiency virus infection)
?	Signs of systemic infection (eg, fever, chills, hypotension)
?	Significant cellulitis (>5 cm of surrounding erythema)