Primary closure of cutaneous abscesses: a systematic review

Cutaneous abscesses have traditionally been treated with incision and drainage followed by secondary healing. Primary closure after incision and drainage is an alternative mode of therapy practiced in some parts of the world. The current study reviews the experience with primary closure of abscesses.

A systematic literature review was conducted using search terms abscess and primary closure. The databases searched included MEDLINE, PubMED, EMBASE, CINHAL, and the Cochrane Library between 1950 and 2009. The reference lists of the retrieved studies were also manually searched for additional studies. We performed a meta-analysis of all randomized clinical trials in which patients were randomized to either primary or secondary closure of incised and drained abscesses using Review Manager software.

Of 33 articles retrieved, there were 7 randomized controlled trials in which 915 patients were randomized to primary (n = 455) or secondary (n = 460) closure. Many abscesses were located in the anogenital region and drained by surgeons. The time to healing after primary closure (7.8 days [95% confidence interval {CI}, 7.3-8.3]) was significantly shorter than that after secondary closure (15.0 days [95% CI, 14.3-15.7]; absolute difference, 7.3 days [95% CI, 6.9-7.6]). The rates of abscess recurrence after primary closure (7.6% [95% CI, 4.6-10.6]) were similar to those after secondary closure (11.1 days [95% CI, 7.5-14.7]; odds ratio, 0.66 [95% CI, 0.35-1.15]).

Studies from 4 countries suggest that primary closure of incised and drained abscesses results in faster healing and similar low abscess recurrence rates than after secondary closure. These studies provide a foundation for which clinical trials can be conducted in the United States.