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How To Incise and Drain an Abscess


Matthew J. Streitz

, MD, San Antonio Uniformed Services Health Education Consortium

Reviewed/Revised Apr 2023

A soft-tissue abscess may need to be incised and drained.

A soft-tissue abscess is typically a palpable, tender, red lump containing pus. There is usually localized induration and some "give" with palpation as opposed to the solid feeling of a mass or nodule. (See also Abscesses Abscesses Abscesses are collections of pus in confined tissue spaces, usually caused by bacterial infection. Symptoms include local pain, tenderness, warmth, and swelling (if abscesses are near the skin... read more .)

Indications for Incising and Draining an Abscess

  • Soft-tissue abscess

For small and/or superficial abscesses, treat initially with heat and oral antibiotics and reevaluate need for drainage after 24 to 48 hours.

Contraindications to Incising and Draining an Abscess

Absolute contraindications

  • None

Relative contraindications

  • Certain abscesses may require drainage in an operating room.

  • Uncertainty whether lesion represents focal cellulitis with induration and swelling or an actual abscess (ultrasonography may be helpful)

Consider operating room management for

  • Abscesses close to major neurovascular structures (eg, the axilla, antecubital fossa, posterior knee, groin area, neck)

  • Infections of the hand other than those limited to the distal finger (because of complicated anatomy and small areas)

  • Facial infections (because adequate anesthesia is difficult and the cavernous venous sinus is nearby for facial abscesses above the upper lip and below the brow)

  • Large or deep abscesses (alternatively, experienced practitioners with available technology may consider doing ultrasound or CT-guided percutaneous needle aspiration)

Complications of Incising and Draining an Abscess

Equipment for Incising and Draining an Abscess

  • Cleansing solution, such as povidone-iodine or chlorhexidine

  • 21- and 25-gauge needles

  • 10-mL syringe

  • Local anesthetic, such as 1% lidocaine

  • Irrigation syringe

  • Hemostat or small forceps

  • #11 scalpel

  • Culture swab

  • Packing material, such as ½- to 1-cm sterile gauze strip

  • Absorptive bulk dressing (such as 4 × 4 gauze squares and tape; circular dry gauze wrap on extremities)

  • Nonsterile gloves

Additional Considerations for Incising and Draining an Abscess

Preincision antibiotics: For patients at high risk of infectious endocarditis complications High-risk patients Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. It may cause fever, heart murmurs, petechiae, anemia, embolic... read more High-risk patients , immunocompromised patients, and IV drug users, pretreat 1 hour before the procedure with antibiotics effective against staphylococci and beta-hemolytic streptococci (eg, a cephalosporin or, if infection with methicillin-resistant staphylococci is possible, vancomycin or clindamycin).

Less invasive alternatives: Avoid aggressive incision in abscesses in cosmetic areas, in areas under significant skin tension (eg, extensor surfaces), and in areas with extensive scar tissue (eg, sites of multiple previous drainage procedures). Instead, use a stab incision or needle aspiration to limit tissue injury and resultant scar formation. Multiple needle aspirations, ultrasound-guided needle aspiration, or delayed incision and drainage may be required. The abscess should be reassessed every 1 to 2 days to determine whether additional intervention is needed.

Relevant Anatomy for Incising and Draining an Abscess

  • Varies by location

Positioning for Incising and Draining an Abscess

  • Patient comfort with excellent exposure of abscess

Step-by-Step Description of Incising and Draining an Abscess

  • Consider parenteral analgesia (eg, fentanyl 1 to 2 mcg/kg IV) for patients with significant pain, anxiety, or large abscesses.

  • If available, point-of-care ultrasound may be used to identify extent of abscess and possible loculations.

  • Cleanse the site with povidone-iodine or chlorhexidine solution.

  • Inject local anesthetic using a 25-gauge needle either along the line of incision over the dome of the abscess, or, more effectively, as a field block around the entire abscess; in some locations, a nerve block also can be used.

  • If injecting along the incision, be careful not to inject into the abscess cavity, which is painful and fails to numb the skin.

  • To create a field block, inject local anesthetic in a diamond-shaped pattern around the entire abscess. Start at one of the apices of the diamond and inject for the length of the needle, then reinsert it through anesthetized skin as you continue around the abscess.

  • Make a linear incision over the full length of the abscess using a #11 scalpel, following skin creases if possible.

  • Gently squeeze the wound to express the pus.

  • Culture of the abscess is not routinely necessary but may be done in patients who have systemic symptoms and signs, severe local infection (cellulitis), recurrent abscesses, or failure of initial antibiotic treatment and in patients at the extremes of age or who are immunocompromised.

  • Sweep a hemostat or forceps around the abscess cavity to break up loculations. Consider using a blunt-ended, rigid suction device to extract pus from large or deep abscesses, which also assists in breaking up loculations.

  • Correct predisposing conditions, such as obstruction of natural drainage (eg, due to redundant skin folds) or the presence of a foreign body.

  • If it is difficult to completely evacuate the abscess contents, irrigate the cavity with normal saline solution.

  • Although packing was commonly done in the past, it is not considered necessary except for pilonidal abscesses > 5 cm and, possibly, abscesses in immunocompromised patients and those with diabetes.

  • Place an absorbent gauze pad over the wound. If on an extremity, secure the pad with circular dry gauze wrap. Splint the affected part if possible, particularly if a joint is affected.

Aftercare for Incising and Draining an Abscess

  • Reevaluate and redress the wound in 24 to 48 hours. Exceptions are some small abscesses, such as paronychias or small furuncles, which do not need to be monitored as closely.

  • Drainage relieves most of the pain of an abscess, but postoperative analgesics may be required.

  • Instruct the patient to elevate the wound and not disturb the dressing and splint before the first follow-up visit.

  • Any packing may be removed once there is healthy granulation tissue throughout the cavity and there is no longer any drainage. Have the patient begin warm soaks and gentle hydrostatic debridement at home (ask the patient to hold the skin incision open and direct the shower or faucet spray into the abscess cavity). Continue dressing changes every 1 to 2 days and follow-up visits as needed until fully healed.

  • Patients should be reevaluated if they have worsening pain, increased drainage, or spreading erythema.


Patients should receive antibiotics for at least 5 to 7 days after the procedure. Consider admission for anyone immunocompromised with systemic symptoms (eg fever, chills) or anyone with signs of sepsis Sepsis and Septic Shock Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure... read more .

A common practice is to give an initial IV dose of antibiotic in the emergency department, followed by oral antibiotics.

Warnings and Common Errors When Incising and Draining an Abscess

  • Do not underestimate the need for analgesia. Inadequate analgesia deters thorough wound care.

  • The skin of a pointing abscess is very thin, making it difficult to inject local anesthetic into the skin rather than the abscess cavity; use a field block instead.

  • Incising skin before pus localizes into an abscess is not curative and may even extend the infectious process. If it is unclear whether pus is present, do ultrasonography or have the patient apply heat and take antibiotics and analgesics (eg, NSAIDs, acetaminophen) and reevaluate in 24 to 48 hours.

  • Without proper incision and drainage, spontaneous rupture and drainage may occur, sometimes leading to the formation of chronic draining sinuses. Incomplete resorption may leave a cystic loculation within a fibrous wall that may become calcified.

  • Perirectal abscesses Treatment An anorectal abscess is a localized collection of pus in the perirectal spaces. Abscesses usually originate in an anal crypt. Symptoms are pain and swelling. Diagnosis is primarily by examination... read more have a high morbidity and mortality if incision and drainage are incomplete and should be evaluated by a surgeon. Patients with large and deep abscesses should be admitted to the hospital for evaluation and treatment under general or spinal anesthesia.

  • A facial abscess above the upper lip and below the brow may drain into the cavernous sinus, so manipulation of an abscess in this area may predispose to septic thrombophlebitis. After incision and drainage, treat with antistaphylococcal antibiotics and warm soaks and have frequent follow-up visits.

Tips and Tricks for Incising and Draining an Abscess

  • When doing a field block, after the first injection always reinsert the needle through anesthetized skin to minimize the number of painful pricks.

  • For breast abscesses, ultrasound-guided needle aspiration, as opposed to formal incision and drainage, is becoming the standard of care.

  • Sebaceous cyst abscesses have a pearly white capsule. The capsule must be removed for complete healing either at the time of abscess drainage or at a follow-up visit once inflammation has resolved.

  • For paronychia, consider simply lifting the eponychial fold away from the nail matrix to allow the pus to drain; after this, adequate drainage is likely.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • Johnson EK. Voel JD, Cowan ML, et al : The American Society of Colon and Rectal Surgeons' clinical practice guidelines for the management of pilonidal disease. Dis Colon Rectum 62:146-157, 2019. doi: 10.1097/DCR.0000000000001237

Drugs Mentioned In This Article

Drug Name Select Trade
Betadine, Betadine Prep, First Aid, GRx Dyne, GRx Dyne Scrub, Povidex , Povidex Peri
Betasept, Chlorostat, Hibiclens, Oro Clense , Peridex, Periogard, PerioRx , Perisol
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme with Lidocaine, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Ela-Max, GEN7T, Glydo, Gold Bond, LidaMantle, Lidocan, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , Lidomar , Lidomark, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, Lidosol, Lidosol-50, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xyliderm, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido
FIRVANQ, Vancocin, Vancocin Powder, VANCOSOL
Cleocin, Cleocin Ovules, Cleocin Pediatric, Cleocin T, CLIN, Clindacin ETZ, Clindacin-P, Clinda-Derm , Clindagel, ClindaMax, ClindaReach, Clindesse, Clindets, Evoclin, PledgaClin, XACIATO
ABSTRAL, Actiq, Duragesic, Fentora, IONSYS, Lazanda, Onsolis, Sublimaze, SUBSYS
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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