Is incision and drainage an open procedure?

September 25, 2025 •

4 min read

According to the American College of Emergency Physicians, a simple incision and drainage (I&D) involves a single cut to release pus and leave the wound open to heal on its own. This healing method is consistent with the definition of an open procedure, allowing the wound to resolve from the inside out.

Quick Summary

Yes, incision and drainage is fundamentally an open procedure, as the incision is deliberately left open, often packed with sterile gauze, to allow the abscess cavity to drain and heal naturally from the bottom up, rather than being sealed with stitches. This process is known as healing by secondary intention.

Key Points

Open Procedure: Incision and drainage is an open procedure because the wound is deliberately left unstitched to allow it to heal from the inside out.
Healing by Secondary Intention: This healing process is crucial for ensuring the abscess cavity continues to drain and does not reform.
Minor Surgery: I&D is considered a minor surgical procedure, often performed in a doctor's office or urgent care under local anesthetic.
Comprehensive Drainage: For complex cases with multiple pockets of pus, the procedure may involve probing the cavity to ensure all loculations are broken up and drained.
Prevents Recurrence: By keeping the wound open and allowing it to drain, I&D is a highly effective method for preventing the abscess from recurring in the same spot.
Post-Procedure Care is Key: Patient involvement in proper wound care and dressing changes is essential for preventing secondary infection and ensuring successful healing.

Understanding the Incision and Drainage (I&D) Procedure

An incision and drainage (I&D) procedure is a standard medical intervention used to treat a localized collection of pus, known as an abscess. While often considered a minor surgery, it is a crucial step in managing infections that antibiotics alone cannot resolve. The primary purpose is to create an opening that allows the infected material to be expelled, relieving pain, reducing inflammation, and preventing the infection from spreading further into the body.

The Open Nature of the Procedure

Answering the core question, is incision and drainage an open procedure?, the answer is a definitive yes. The defining characteristic that makes I&D an 'open' procedure is the healing process. Following the drainage of the abscess, the medical provider does not typically close the wound with sutures. Instead, the wound is left open to heal naturally. This is done for a very specific and important reason: it allows the wound to continue draining any remaining pus or debris, ensuring that the infection is fully cleared. This healing method, known as healing by secondary intention, prevents the re-formation of the abscess.

What Happens During an I&D?

The procedure is usually quick and can be performed in a doctor's office or urgent care center under local anesthesia, though larger or deeper abscesses may require more extensive measures.

Preparation: The area around the abscess is cleaned and sterilized with an antiseptic solution.
Anesthesia: Local anesthetic is injected to numb the site of the incision, minimizing discomfort.
Incision: A sterile scalpel is used to make a small cut over the abscess to release the pus.
Drainage: The pus is gently expressed from the cavity. For larger abscesses with multiple pockets (loculations), a medical provider may insert a tool, like a hemostat, to break up these pockets and ensure complete drainage.
Irrigation: The empty cavity is flushed with a sterile saline solution to clean out any residual bacteria and debris.
Packing: For deeper or larger wounds, sterile gauze packing may be inserted into the cavity. This packing helps keep the wound open and allows for continuous drainage, as well as promoting healing from the inside out.
Dressing: A sterile dressing is placed over the wound to absorb drainage and protect the area.

Comparing I&D to Other Drainage Methods

It is important to understand that not all drainage procedures are alike. While traditional I&D is an open procedure, other techniques exist.


Feature	Incision and Drainage (Open)	Percutaneous Drainage (Minimally Invasive)	Primary Closure (Closed)
Technique	Small incision with packing to promote healing from the inside out.	Image-guided needle aspiration and catheter placement through a pinhole incision.	Wound is sutured closed after drainage and curettage.
Use Case	Most superficial skin and soft tissue abscesses.	Deeper, intra-abdominal abscesses.	May be considered in specific, low-risk cases, but has higher recurrence rate.
Healing	By secondary intention; wound left open.	Healing around the catheter, then closing naturally.	By primary intention; wound is sealed.
Anesthesia	Local anesthetic in most cases.	Sedation and local anesthetic.	Can be local or general, depending on severity.
Hospitalization	Often outpatient; in-office procedure.	Can be outpatient but may require hospital stay.	Varies, depending on complexity.

Aftercare and Recovery

Recovery from an I&D procedure is a critical part of the process and involves active patient participation. Depending on the size of the abscess, complete healing can take one to several weeks. Following the medical provider's instructions is vital to prevent complications.

Wound Care: Keep the wound clean and dry. Regularly change the dressing as instructed to manage drainage.
Packing Removal: If packing was used, you will likely need a follow-up appointment for its removal or may be instructed on how to do it yourself.
Antibiotics: Oral antibiotics may be prescribed to ensure the infection is completely eradicated.
Pain Management: Over-the-counter pain relievers can help manage discomfort.

Potential Risks and Complications

While I&D is a safe and common procedure, a few risks exist:

Infection: A small risk of secondary infection if the wound is not cared for properly.
Scarring: Some scarring is possible, depending on the abscess size and location.
Recurrence: The abscess may come back if not fully drained or if an underlying cause isn't addressed.
Bleeding: Mild bleeding is normal, but excessive bleeding requires medical attention.

For more detailed information on wound care and healing processes, you can refer to authoritative sources like the NIH Bookshelf on Incision and Drainage.

Conclusion

In conclusion, an incision and drainage procedure is, by its very nature, an open surgical procedure. The decision to leave the wound open is a deliberate medical choice to facilitate proper drainage and healing from the deepest point of the abscess, a process that is key to resolving the infection effectively. Understanding this aspect of the procedure can help patients better prepare for their treatment and recovery. Proper wound care following the I&D is essential for a successful outcome and to prevent recurrence.

Frequently Asked Questions

The wound is left open to allow for continuous drainage of any remaining pus and debris. This method, known as healing by secondary intention, ensures the infection is completely cleared and prevents the abscess from reforming.

A local anesthetic is used to numb the area before the incision is made, so you should not feel any pain during the procedure. Some discomfort may be felt afterward, which can be managed with over-the-counter pain medication.

Healing time varies depending on the size and depth of the abscess. Minor wounds may heal in 1 to 2 weeks, while larger ones can take longer. Your doctor will provide specific guidance for your case.

Yes, many I&D procedures, especially for superficial abscesses, are considered minor surgery and are commonly performed in an office or urgent care setting.

A simple I&D involves a single incision to drain pus. A complicated I&D may require multiple incisions, packing the wound, or breaking up internal pockets of pus called loculations.

While generally safe, potential risks include secondary infection, scarring, bleeding, or the abscess recurring. Following all post-procedure care instructions is the best way to minimize risks.

In cases of larger or deeper abscesses, a sterile gauze packing is inserted into the wound. This keeps the incision open and helps absorb any continued drainage, promoting healing from the inside out.

Alternatives may exist for very specific cases, such as percutaneous drainage for deeper abscesses, though I&D is the standard for most skin abscesses. Simply taking antibiotics is often not enough to clear the infection.