Is delayed changing of dressings (past 48 hour) after abscess drainage associated with an increased risk of cellulitis? Any studies to show that?

It is a difficult question. I didn't find any article about this issue.

Question is which kind of abscess, localization, which kind of dressings? For my opinion, there is no indication for wound dressing after abscess incision and drainage., and I thing that is no dressing which can disable cellulitis.

in letteratura non c'è molto, considerare l'esperienza personale, in genere la prima medicazione se non ha avuto complicanze, meglio sporca o infetta, si deve eseguire dopo 48 ore poi medicazione ogni 24 ore, in condizioni ovviamente di sterilità.

I feel that the answer is definitely "yes" Delayed dressing change after I&D causes discharge embedded within the wound, which lead to subQ, dermal edema, arteriolar and venule congestion and subsequent more chance of infection.

In my experience, after I & D, the abcess will resolve much faster with saline irrigation and regular dressing changes. In the patients who are hospitalized, we find that the abcess tends to extend if we don't irrigate and change the dressings. We tend to dress or pack the I & D site with 0.125% sodium hypochlorite solution.

In terms of cellulits, the real question is does the patient have weeping or drainage? If drainage is allowed to sit on the skin or form a crust, it is a perfect environment for bacterial proliferation. I see cellulitis patients frequently in my practice. I always have the nurse wash the area daily and apply a moisturizing ointment.

If there is drainage or weeping, we apply a non-adherent dressing that will control the moisture. If the patient has massive edema with large volume drainage, we usually wash twice a day, moisturize and wrap in a large underpad or adult brief to control drainage.

Obviously, this is in addition to appropriate antibiotic therapy. Cleaning the area and controlling drainage seems to help the cellulitis resolve a bit faster.

I am intrigued by the rationale of delayed dressing change after abscess drainage. One theoretical reason may be the avoidance of pain. Most surgeons I know would change the pack or dressing within 24 hours. My experience with this regimen is that any cellulitis will improve even without antibiotics.

Thank you all. i had a patient who delayed with the pack and dressing after I&D of a cutaneous leg abscess. she presented after 48 hours with localized cellulitis and swelling.

i appreciate all your repsonses.

I don't find any refrence you may report it .But I have also personaly observed that if u leave abscess cavity packed longerthan 48 -72 hrs some fellow is going to have cellulitis .But it is due to inadequate drainage and breaking of septa and or resistant antibiotic infection Pl go through following link will give u a clue . study shows that silver sulfadiazine may be retard burn wound healing and has

demonstrable deleterious effects on burn wound healing

in full-thickness burn wounds as compared to normal saline dressings.

so for as wound packing is concerned, it should not be tightly packed after I & D of an abscess, so that the Gauge packed can soak the discharges thus reduce the irritation/reaction to the adjacent tissue.In an abscess collection of pus after I&D is always create problem.

I don't think there would be a single answer that would fit all situations. The important factors to consider would be the wound, the organism and the host factors. For a clean, granulating abscess cavity in an immunocompetent host, the dressing can be changed at an interval of 48 hours and delays should not be too bothersome.. On the other hand, for an infected abscess cavity in a patient with a compromised immune function and a resistant hospital acquired organism, it would be sensible to change dressings regularly and frequently...

We routinely drain facial abscess, and on the first two days, more frequent dressing changes have been required. The dressing changes are done once it is soaked.

That was our only guiding principle in early period after drainage Not much of a difference. But we have never left the patient without a first dressing change which we had to do before we discharge the patient from day care. (mostly about 2-4 hours after ther procedure if done under local anesthesia) because the dressing is already soaked by then. If it cannot be done by a medical professional, the dressing changes can be done even by the patient or care taker themselves.

The concept of 'delayed dressing change' is applicable in other non draining wounds to allow for epithelialisation and to permit undisturbed healing ... In a wound after I&D the idea is to keep the drainage port open to permit complete drainage. On this principle too, frequent dressing change appears to be indicated.

I do not have any study to prove or disprove these principles though. Is anyone aware of any well conducted study trials in this regard ?

I agree with Raza that there is no universal concept / rule but it should be based on case by case basis.

Regards,

Dr. Akilesh. R

India

...I do not know but it makes sense and science to change a wound dressing after macroscopic infection elimination as soon as it is wet again or has not collected or absorbed anything at daily or half daily check. The inflammatory response reaches is full power at 6 hours so it is reasonable to change dressing keeping in mind each of these known factors after wound inspection.

In war surgery gsw on limbs are treated with DPC of soft tissues after debridement (source elimination) and the wound is dressed (gauze, cotton and crepe bandage) and left untouched for five days unless undue rise of WBC or temp or HR not attributable to other causes or in presence of smell different (foul or more marked) from the usual expected (mild fish smell) or visible pus/exudate. If everything had gone well, you can do your DPC of soft tissues e.g. amp.s closure.

This obviously pertains to 'contaminated wounds' and 'trasudation' and not to 'already infected wounds' with pus/exudate, like the one you are referring to, which I would see anytime between 6 to 24-48 hours maximum before changing of dressing, depending on dressing inspection. Remember that unless there is nothing to collect or absorb the dressing itself may be cause of stagnation of contaminated or infected material by blocking mechanically trasudation that will become exudate and later pus.

It is therefore difficult to answer to your question due to the multiplicity of factors involved to take in consideration.

Dressing in contaminated wounds or clean wounds serve the purpose of absorption of trasudate and normal fluids due to the physiological loss of continuity in tissues and of stimulation of granulation tissue formation. This is why in clean war wounds the dressing is pressed.

On abscess cavities I use loose gauze dressing to collect further fluids with exudates and pus, in the same time allowing exit of bad stuff; if you put a compact firm dressing then you will get recurrence or cellulitis. Persistence of exudate or ascess indicates you have to review, further excide its margins to clear granulation tissue.

...probably not well expressed or misread.

Cleaning of exudates and pus/necrosis evacuation is an obvious must. Packing not on the abscess or necrosis but use loose gauze after source elimination. IRC and military have nailed this truth well. They wash wounds like you wash your car in fact. You do source elimination even with further wound excision if necessary or refractory.

I am distinguishing between the packing to stimulate gran tissue formatioin in healthy or trasudate forming wound. Smell and clinical follow up will tell you. You do not pack if exudate or pus or necrosis are the situation - basic principle!. Lose gauze is practical and indicative in the same time in clean or clean-contaminated (oxymor) wounds.

There is no need to pack an abscess cavity. If deep, a wick may be required to prevent the incision prematurely closing.