Abscess Treatment: What to Expect During Incision & Drainage (I&D)

I&D is the definitive treatment for a fluctuant abscess. Pain control is central.

Procedure Steps

1. Assessment: Fluctuation, overlying cellulitis, systemic signs. POCUS if deep/uncertain.
2. Anesthesia: Field block (1% lidocaine ± epi) or regional block. Topical EMLA insufficient for deep I&D. Buffering reduces sting.
3. Incision: #11/15 blade; stab incision at most dependent point; length = 1–2 cm (adequate drainage). Cruciate/elliptical for loculated.
4. Drainage: Express pus; break loculations with hemostat. Culture (aerobic/anaerobic) if indicated.
5. Irrigation: Copious saline.
6. Packing: Iodoform or plain gauze strip (prevents premature closure). Not needed for small, well-drained abscesses.
7. Dressing: Absorbent pad, occlusive cover.

Aftercare

• Recheck 24–48 hrs: remove packing, reassess, repack if needed.
• Daily wound care (shower, repack) until granulating.
• Antibiotics: Not routine for simple drained abscess in immunocompetent. Indicated: cellulitis >5 cm, fever, immunosuppression, prosthetic/vascular graft, SIRS.
• Pain: NSAIDs ± short opioid.

Red Flags for Return

Spreading redness, fever >101°F, increasing pain, no drainage improvement at 48 hrs.