Upending another slice of traditional dogma, brought to my attention by Andy Neill, this is a systematic review and meta-analysis of the 7 randomized clinical trials comparing primary closure of cutaneous abscesses with secondary. I love articles that challenge routine practice – some of which was actually transcribed from stone tablets into Tintanelli by Moses.
Unfortunately, as weak as the evidence may be for packing abscesses, antibiotics with abscess, etc., the evidence from this meta-analysis really is only serviceable as underpinnings to justify further trials revisiting standard practice. The 915 patients included in this meta-analysis were primarily anogenital abscesses drained in an operating room environment by surgeons and many received antibiotics. Some of the outcomes measured in this study make sense and are probably generalizable – healing time and time off work – which obviously will favor the patients with primary closure. The less generalizable is the 600 patient subset which tracked abscess recurrence, which also has a ton of heterogeneity between studies.
Is it reasonable to perform some sort of abscess closure? I think it probably is – depending on the amount of potential disfigurement, there's probably a discussion of risk/benefit that can be had. There are also probably varying techniques of suturing that could be entertained, loosely approximating some part of the abscess, perhaps with a wick, rather than tightly re-approximating skin edges.
The authors state they are undertaking their own randomized trial.
"Primary closure of cutaneous abscesses:
a systematic review"