I’ve recently shared posts on Loop abscess and drainage as well as on the utility and need for packing abscesses. I’ve concluded, for the time being, that it is likely appropriate to pack abscesses greater than 5cm. But, is there something other than stuffing a bunch of gauze in there that would do the trick as well?
The answer, as you’d surmise if you’ve read the blog, is absolutely. In larger abscesses surgeons (and some ED providers) will often place a flexible drain in the wound. There are a few options (see pictures below) that may work. The basic technique involves threading the drain into the wound, then cutting the tail so that it protrudes approximately 2cm out of the wound. You can then suture it in place – often with an absorbable suture like chromic gut or a non absorbable such as Prolene. Then, it can be removed within the next 7-10days as the abscess heals. In their, this technique leads to material that stays in place longer and is less likely to fall out. It can also be more comfortable – as there is a smaller volume of material in the wound.
This would be appropriate for any abscess, especially a pilonidal, except for the face.
Ultimately, I would still probably choose to go with Loop I&D as it is simpler and easier to care for.
Examples of drains
Vessel Loop
Penrose
Malecot
Good ‘ole Foley
