They result when oil-producing or sweat glands are obstructed, and bacteria are trapped. Always follow your healthcare professional's instructions. The goal of treatment is to eliminate the bacteria without further damage to the underlying tissue. 3 0 obj The Laboratory Risk Indicator for Necrotizing Fasciitis score uses laboratory parameters to stratify patients into high- and low-risk categories for necrotizing fasciitis (Table 4); a score of 6 or higher is indicative, whereas a score of 8 or higher is strongly predictive (positive predictive value = 93.4%).19, Blood cultures are unlikely to change the management of simple localized SSTIs in otherwise healthy, immunocompetent patients, and are typically unnecessary.20 However, because of the potential for deep tissue involvement, cultures are useful in patients with severe infections or signs of systemic involvement, in older or immunocompromised patients, and in patients requiring surgery.5,21,22 Wound cultures are not indicated in most healthy patients, including those with suspected MRSA infection, but are useful in immunocompromised patients and those with significant cellulitis; lymphangitis; sepsis; recurrent, persistent, or large abscesses; or infections from human or animal bites.22,23 Tissue biopsies, which are the preferred diagnostic test for necrotizing SSTIs, are ideally taken from the advancing margin of the wound, from the depth of bite wounds, and after debridement of necrotizing infections and traumatic wounds. Practice and instruct in good handwashing and aseptic wound care. Home| Family physicians often treat patients with minor wounds, such as simple lacerations, abrasions, bites, and burns. All rights reserved. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Repeat this step until the drainage has stopped. Gentle heat will increase blood flow, and speed healing. Because wounds can quickly become infected, the most important aspect of treating a minor wound is irrigation and cleaning. Discover how to lessen their appearance or get rid of them permanently. Mayo Clinic Staff. <> Discover home remedies for boils, such as a warm compress, oil, and turmeric. MRSA infection. Tap water produces similar outcomes to sterile saline irrigation of minor wounds. A blocked oil gland, a wound, an insect bite, or a pimple can develop into an abscess. An abscess incision and drainage (I and D) is a procedure to drain pus from an abscess and clean it out so it can heal. The abscess drainage procedure itself is fairly simple: If it isnt possible to use local anesthetic or the drainage will be difficult, you may need to be placed under sedation, or even general anesthesia, and treated in an operating room. 2 0 obj Copyright Merative 2022 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting. Recovery time from abscess drainage depends on the location of the infection and its severity. None of the studies demonstrated a difference in treatment failure rates, recurrence rates, or need for secondary interventions in non-packed wounds; however, packing groups had more pain. Schedule an Appointment. 2021 Jul 27;13:335-341. doi: 10.2147/OAEM.S317713. A skin abscess, sometimes referred to as a boil, can form just about anywhere on the body. Clipboard, Search History, and several other advanced features are temporarily unavailable. Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for. Empiric antibiotic treatment should be based on the potentially causative organism. Incision and drainage after care? 98 0 obj <>stream Abscess drainage is usually a safe and effective way of treating a bacterial infection of the skin. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Rhle A, Oehme F, Brnert K, Fourie L, Babst R, Link BC, Metzger J, Beeres FJ. Change the dressing if it becomes soaked with blood or pus. Data Sources: A PubMed search was completed using the key term skin and soft tissue infections. Hearns CW. A Cochrane review did not establish the superiority of any one pathogen-sensitive antibiotic over another in the treatment of MRSA SSTI.35 Intravenous antibiotics may be continued at home under close supervision after initiation in the hospital or emergency department.36 Antibiotic choices for severe infections (including MRSA SSTI) are outlined in Table 6.5,27, For polymicrobial necrotizing infections; safety of imipenem/cilastatin in children younger than 12 years is not known, Common adverse effects: anemia, constipation, diarrhea, headache, injection site pain and inflammation, nausea, vomiting, Rare adverse effects: acute coronary syndrome, angioedema, bleeding, Clostridium difficile colitis, congestive heart failure, hepatorenal failure, respiratory failure, seizures, vaginitis, Children 3 months to 12 years: 15 mg per kg IV every 12 hours, up to 1 g per day, Children: 25 mg per kg IV every 6 to 12 hours, up to 4 g per day, Children: 10 mg per kg (up to 500 mg) IV every 8 hours; increase to 20 mg per kg (up to 1 g) IV every 8 hours for Pseudomonas infections, Used with metronidazole (Flagyl) or clindamycin for initial treatment of polymicrobial necrotizing infections, Common adverse effects: diarrhea, pain and thrombophlebitis at injection site, vomiting, Rare adverse effects: agranulocytosis, arrhythmias, erythema multiforme, Adults: 600 mg IV every 12 hours for 5 to 14 days, Dose adjustment required in patients with renal impairment, Rare adverse effects: abdominal pain, arrhythmias, C. difficile colitis, diarrhea, dizziness, fever, hepatitis, rash, renal insufficiency, seizures, thrombophlebitis, urticaria, vomiting, Children: 50 to 75 mg per kg IV or IM once per day or divided every 12 hours, up to 2 g per day, Useful in waterborne infections; used with doxycycline for Aeromonas hydrophila and Vibrio vulnificus infections, Common adverse effects: diarrhea, elevated platelet levels, eosinophilia, induration at injection site, Rare adverse effects: C. difficile colitis, erythema multiforme, hemolytic anemia, hyperbilirubinemia in newborns, pulmonary injury, renal failure, Adults: 1,000 mg IV initial dose, followed by 500 mg IV 1 week later, Common adverse effects: constipation, diarrhea, headache, nausea, Rare adverse effects: C. difficile colitis, gastrointestinal hemorrhage, hepatotoxicity, infusion reaction, Adults and children 12 years and older: 7.5 mg per kg IV every 12 hours, For complicated MSSA and MRSA infections, especially in neutropenic patients and vancomycin-resistant infections, Common adverse effects: arthralgia, diarrhea, edema, hyperbilirubinemia, inflammation at injection site, myalgia, nausea, pain, rash, vomiting, Rare adverse effects: arrhythmias, cerebrovascular events, encephalopathy, hemolytic anemia, hepatitis, myocardial infarction, pancytopenia, syncope, Adults: 4 mg per kg IV per day for 7 to 14 days, Common adverse effects: diarrhea, throat pain, vomiting, Rare adverse effects: gram-negative infections, pulmonary eosinophilia, renal failure, rhabdomyolysis, Children 8 years and older and less than 45 kg (100 lb): 4 mg per kg IV per day in 2 divided doses, Children 8 years and older and 45 kg or more: 100 mg IV every 12 hours, Useful in waterborne infections; used with ciprofloxacin (Cipro), ceftriaxone, or cefotaxime in A. hydrophila and V. vulnificus infections, Common adverse effects: diarrhea, photosensitivity, Rare adverse effects: C. difficile colitis, erythema multiforme, liver toxicity, pseudotumor cerebri, Adults: 600 mg IV or orally every 12 hours for 7 to 14 days, Children 12 years and older: 600 mg IV or orally every 12 hours for 10 to 14 days, Children younger than 12 years: 10 mg per kg IV or orally every 8 hours for 10 to 14 days, Common adverse effects: diarrhea, headache, nausea, vomiting, Rare adverse effects: C. difficile colitis, hepatic injury, lactic acidosis, myelosuppression, optic neuritis, peripheral neuropathy, seizures, Children: 10 to 13 mg per kg IV every 8 hours, Used with cefotaxime for initial treatment of polymicrobial necrotizing infections, Common adverse effects: abdominal pain, altered taste, diarrhea, dizziness, headache, nausea, vaginitis, Rare adverse effects: aseptic meningitis, encephalopathy, hemolyticuremic syndrome, leukopenia, optic neuropathy, ototoxicity, peripheral neuropathy, Stevens-Johnson syndrome, For MSSA, MRSA, and Enterococcus faecalis infections, Common adverse effects: headache, nausea, vomiting, Rare adverse effects: C. difficile colitis, clotting abnormalities, hypersensitivity, infusion complications (thrombophlebitis), osteomyelitis, Children: 25 mg per kg IM 2 times per day, For necrotizing fasciitis caused by sensitive staphylococci, Rare adverse effects: anaphylaxis, bone marrow suppression, hypokalemia, interstitial nephritis, pseudomembranous enterocolitis, Adults: 2 to 4 million units penicillin IV every 6 hours plus 600 to 900 mg clindamycin IV every 8 hours, Children: 60,000 to 100,000 units penicillin per kg IV every 6 hours plus 10 to 13 mg clindamycin per kg IV per day in 3 divided doses, For MRSA infections in children: 40 mg per kg IV per day in 3 or 4 divided doses, Combined therapy for necrotizing fasciitis caused by streptococci; either drug is effective in clostridial infections, Adverse effects from penicillin are rare in nonallergic patients, Common adverse effects of clindamycin: abdominal pain, diarrhea, nausea, rash, Rare adverse effects of clindamycin: agranulocytosis, elevated liver enzyme levels, erythema multiforme, jaundice, pseudomembranous enterocolitis, Children: 60 to 75 mg per kg (piperacillin component) IV every 6 hours, First-line antimicrobial for treating polymicrobial necrotizing infections, Common adverse effects: constipation, diarrhea, fever, headache, insomnia, nausea, pruritus, vomiting, Rare adverse effects: agranulocytosis, C. difficile colitis, encephalopathy, hepatorenal failure, Stevens-Johnson syndrome, Adults: 10 mg per kg IV per day for 7 to 14 days, For MSSA and MRSA infections; women of childbearing age should use 2 forms of birth control during treatment, Common adverse effects: altered taste, nausea, vomiting, Rare adverse effects: hypersensitivity, prolonged QT interval, renal insufficiency, Adults: 100 mg IV followed by 50 mg IV every 12 hours for 5 to 14 days, For MRSA infections; increases mortality risk; considered medication of last resort, Common adverse effects: abdominal pain, diarrhea, nausea, vomiting, Rare adverse effects: anaphylaxis, C. difficile colitis, liver dysfunction, pancreatitis, pseudotumor cerebri, septic shock, Parenteral drug of choice for MRSA infections in patients allergic to penicillin; 7- to 14-day course for skin and soft tissue infections; 6-week course for bacteremia; maintain trough levels at 10 to 20 mg per L, Rare adverse effects: agranulocytosis, anaphylaxis, C. difficile colitis, hypotension, nephrotoxicity, ototoxicity. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. 2010 Jun;22(3):273-7. doi: 10.1097/MOP.0b013e328339421b. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. YL{54| However, home remedies could help, like apple cider vinegar and tea tree oil. You can expect a little pus drainage for a day or two after the procedure. Antibiotics may be given to help prevent or fight infection. Systemic features of infection may follow, their intensity reflecting the magnitude of infection. JMIR Res Protoc. Learn the Signs, Overview of Purpuric Rash, a Symptom of Some Conditions, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, How to Get Rid of Dark Circles Permanently. There are, however, other causes of. About 10% to 30% of all breast abscesses occur after pregnancy, when nursing mothers breastfeed newborns. Nonsuperficial mild to moderate wound infections can be treated with oral antibiotics. Doral Urgent Care. A skin incision is made with a No.. Epub 2009 May 5. Certain medical conditions or other factors may increase your risk of perineal abscesses. Search dates: February 1, 2014 to September 19, 2014. A doctor will numb the area around the abscess, make a small incision, and allow the pus. Prior to making an incision, your doctor will clean and sterilize the affected area. :F. If it is covered in pus and blood, that is good, because it means that the abscess is draining well. You may need to return in 1 to 3 days to have the gauze in your wound removed and your wound examined. Routine cultures and antibiotics are usually unnecessary if an abscess is properly drained. You may feel resistance as the incision is initiated. In contrast, complicated infections can be mono- or polymicrobial and may present with systemic inflammatory response syndrome. This may also help reduce swelling and start the healing. In these cases, systemic antifungals with coverage of Candida, Aspergillus, and Zygomycetes should be considered.28,29,37, Most wounds can be managed by primary care clinicians in the outpatient setting. Uncomplicated purulent SSTIs in easily accessible areas without overlying cellulitis can be treated with incision and drainage only; antibiotic therapy does not improve outcomes. Persons with hearing or speech disabilities may contact us via their preferred Telecommunication Relay endstream endobj startxref This site needs JavaScript to work properly. and transmitted securely. A dressing that gets wet will need to be changed. Skin abscesses can be a significant source of morbidity and are frequently encountered by physicians across the country. 2017 May 1;6(5):e77. The operation is performed under general anaesthesia. S. aureus and streptococci are responsible for most simple community-acquired SSTIs. Blood cultures seldom change treatment and are not required in healthy immunocompetent patients with SSTIs. If your abscess was opened with an Incision and Drainage: Keep the abscess covered 24 hours a day, removing bandages once daily to wash with warm soap and water. Incision and drainage (I&D) remains the standard of care; however, significant variability exists in the treatment of abscesses after I&D. Some recent evidence has suggested that routinely performed treatment modalities may not be beneficial. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. This content is owned by the AAFP. Objective: & Accessibility Requirements. There is limited evidence to suggest one topical agent over another, except in the case of suspected methicillin-resistant Staphylococcus aureus infection, in which mupirocin 2% cream or ointment is superior to other topical agents and certain oral antibiotics.3335, Empiric oral antibiotics should be considered for nonsuperficial mild to moderate infections.30,31 Most infections in nonpuncture wounds are caused by staphylococci and streptococci and can be treated empirically with a five-day course of a penicillinase-resistant penicillin, first-generation cephalosporin, macrolide, or clindamycin. Healing could take a week or two, depending on the size of the abscess. Are there other treatments that can be used to heal skin abscesses? Some of the things you can follow on your own are: Keep the abscess area clean. ariahealth.org/programs-and-services/radiology/interventional-radiology/abscess-and-fluid-drainage, saem.org/cdem/education/online-education/m3-curriculum/group-emergency-department-procedures/abscess-incision-and-drainage, mayoclinic.org/diseases-conditions/mrsa/symptoms-causes/syc-20375336, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, How to Get Rid of a Boil: Treating Small and Large Boils, Identifying boils: Differences from cysts and carbuncles, Is It a Boil or a Pimple? Language assistance services are availablefree of charge. Common simple SSTIs include cellulitis, erysipelas, impetigo, ecthyma, folliculitis, furuncles, carbuncles, abscesses, and trauma-related infections6 (Figures 1 through 3). endstream endobj 50 0 obj <. The area around your abscess has red streaks or is warm and painful. PMC If so, it should be removed in 1 to 2 days, or as advised. Your doctor may send a sample of the pus to a lab for a culture to determine the cause of the bacterial infection. Change thedressing if it becomes soaked with blood or pus. Superficial mild infections can be treated with topical agents, whereas mild and moderate infections involving deeper tissues should be treated with oral antibiotics. Care Instructions| Discussion: You may also be advised to gently clean the area with soap and warm water before putting on new dressing. 2005-2023 Healthline Media a Red Ventures Company. 0. Simple infection with no systemic signs or symptoms indicating spread, Infection with systemic signs or symptoms indicating spread, Infection with signs or symptoms of systemic spread, Infection with signs of potentially fatal systemic sepsis, Immunocompromise (e.g., human immunodeficiency virus infection, chemotherapy, antiretroviral therapy, disease-modifying antirheumatic drugs), Collection of pus with surrounding granulation; painful swelling with induration and central fluctuance; possible overlying skin necrosis; signs or symptoms of infection, Cat bites become infected more often than dog or human bites (30% to 50%, up to 20%, and 10% to 50%, respectively); infection sets in 8 to 12 hours after animal bites; human bites may transmit herpes, hepatitis, or human immunodeficiency virus; may involve tendons, tendon sheaths, bone, and joints, Traumatic or spontaneous; severe pain at injury site followed by skin changes (e.g., pale, bronze, purplish red), tenderness, induration, blistering, and tissue crepitus; diaphoresis, fever, hypotension, and tachycardia, Infection or inflammation of the hair follicles; tends to occur in areas with increased sweating; associated with acne or steroid use; painful or painless pustule with underlying swelling, Genital, groin, or perineal involvement; cellulitis, and signs or symptoms of infection, Walled-off collection of pus; painful, firm swelling; systemic features of infection; carbuncles are larger, deeper, and involve skin and subcutaneous tissue over thicker skin of neck, back, and lateral thighs, and drain through multiple pores, Common in infants and children; affects skin of nose, mouth, or limbs; mild soreness, redness, vesicles, and crusting; may cause glomerulonephritis; vesicles may enlarge (bullae); may spread to lymph nodes, bone, joints, or lung, Spreading infection of subcutaneous tissue; usually affects genitalia, perineum, or lower extremities; severe, constant pain; signs or symptoms of infection. If the patient is seen in a primary care setting by a provider that is not comfortable in performing these procedures, the patient may be started on antibiotics and referred to a general surgeon for definitive treatment. If the abscess was packed (with a cotton wick), leave it in until instructed by your clinician to remove the packing or return for re-evaluation. For example, a perianal abscess almost exclusively general anaesthetic (GA) or spinal. eCollection 2021. V+/T >`xG; |L\rC/.)cOs[&`(&I{WVj6}\,2a Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections. See permissionsforcopyrightquestions and/or permission requests. Tap water and sterile saline irrigation of uncomplicated skin lacerations appear to be equally effective. MeSH The lower extremities are most commonly involved.9 Induration is characteristic of more superficial infections such as erysipelas and cellulitis. J Clin Aesthet Dermatol. They may make a small incision in your skin over the abscess, then insert a thin plastic tube called a drainage catheter into it. CB2ft U xf3jpo@0DP*(Q_(^~&i}\"3R T&3vjg-==e>5yw/Ls[?Y]ounY'vj;!f8 BiO59P]R)B}7B\0Dz=vF1lhuGh]G'x(#1#aK If you follow your doctors advice about at-home treatment, the abscess should heal with little scarring and a lower chance of recurrence. Soaking a cloth compress in hot water and Epsom salt and applying it gently to an abscess a few times a day may also help dry it out. Simply use a dressing gauze that can be purchased from any pharmacy . 0 Extensive description of the technique for incision and drainage is found elsewhere (see "Techniques for skin abscess drainage"). Although it is less invasive, needle aspiration of abscess contents is not recommended . Widespread fungal infection is a rare but serious complication of broad-spectrum antibiotic use in burns. 8600 Rockville Pike If a gauze packing was put in your wound, it should be removed in 1 to 2 days, or as directed. Posted in Cyst Popping Tagged abscess drainage procedure., abscess drainage videos, abscess healing stages, care after abscess incision and drainage, hard lump after abscess drained, how to drain abscess at home, how to tell if abscess is healing, what to expect after abscess drainage Leave a Comment on Inflamed Abscess Drainage Post . Diagnostic testing should be performed early to identify the causative organism and evaluate the extent of involvement, and antibiotic therapy should be commenced to cover possible pathogens, including atypical organisms that can cause serious infections (e.g., resistant gram-negative bacteria, anaerobes, fungi).5, Specific types of SSTIs may result from identifiable exposures. Management is determined by the severity and location of the infection and by patient comorbidities. Apply non-stick dressing or pad and tape. 15,22,23 The addition of systemic antibiotic therapy is recommended if the patient has signs and symptoms of illness, rapid progression, failure to respond to incision and drainage alone, associated comorbidities or immunosuppression, abscess in . However, tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. This fluid drained can be an area of infection such as an abscess or it may be an area of hematoma or seroma. Author disclosure: No relevant financial affiliations. It is the primary treatment for skin and soft tissue abscesses, with or without adjunctive antibiotic therapy. Abscess Drainage. Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up. The primary way to treat an abscess is via incision and drainage. Local anesthetic such as lidocaine or bupivacaine should be injected within the roof of the abscess where the incision will be made. First, your healthcare provider will apply a local anesthetic to the area around the abscess. Ideally, make second small (4-5mm) incision within 4 cm of the first. Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics. The .gov means its official. If you were prescribed antibiotics, take them as directed until they are all gone. KALYANAKRISHNAN RAMAKRISHNAN, MD, ROBERT C. SALINAS, MD, AND NELSON IVAN AGUDELO HIGUITA, MD. Wounds on the head and face may be closed up to 24 hours from the time of injury. The catheter allows the pus to drain out into a bag and may have to be left in place for up to a week. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. A doctor will numb the area around the abscess, make a small incision, and allow the pus inside to drain. Although patients are often instructed to keep their wounds covered and dry after suturing, they can get wet within the first 24 to 48 hours without increasing the risk of infection. This can help speed up the healing process. However, you should check with your doctor or a nurse about home care. 2013 Sep;48(9):1962-5. doi: 10.1016/j.jpedsurg.2013.01.027. Monomicrobial necrotizing fasciitis caused by streptococcal and clostridial infections is treated with penicillin G and clindamycin; S. aureus infections are treated according to susceptibilities. We will help to teach you (or a family member) how to care for your wound. Incision and Drainage (Abscess) Wound Care Instructions Leave pressure dressing on and dry for 24 hours. In studies of clean surgical incisions, there was no high-quality evidence that one antiseptic was superior to another for preventing wound infections. The skin around the abscess may look red and feel tender and warm. After you have an abscess drained, the doctor might prescribe oral antibiotics to help heal your infection. All rights reserved. A small abscess with little pain, swelling, or other symptoms can be watched for a few days and treated with a warm compress to see if it recedes. It involves making an incision into the abscess, breaking down the loculated areas, and washing out the pus as thoroughly as possible. Abscess drainage is usually a safe and effective way of treating a bacterial infection of the skin. Most severe wound infections, and moderate infections in high-risk patients, require initial parenteral antibiotics, with transition to oral antibiotics after therapeutic response. Call your healthcare provider right away if any of these occur: Red streaks in the skin leading away from the wound, Continued pus draining from the wound 2 days after treatment, Fever of 100.4F (38C) or higher, or as directed by your provider. Serious complications from infected animal or human bites include septic arthritis, osteomyelitis, subcutaneous abscess, tendinitis, and bacteremia.30 Common organisms in domestic animal bite wounds include Pasteurella multocida, S. aureus, Bacteroides tectum, and Fusobacterium, Capnocytophaga, and Porphyromonas species. At the very least, a dressing change will be necessary anywhere from a few days to a week after the procedure. After the pus has drained out, your doctor cleans out the pocket with a sterile saline solution. Necrotizing Fasciitis. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. Bookshelf Incision and drainage are required for definitive treatment; antibiotics alone are not sufficient. Three randomized control trials (RCT) and one observational study investigated wound packing versus no packing following I&D. What is abscess drainage? Consensus guidelines recommend trimethoprim/sulfamethoxazole or tetracycline if methicillin-resistant S. aureus infection is suspected,30 although a Cochrane review found insufficient evidence that one antibiotic was superior for treating methicillin-resistant S. aureuscolonized nonsurgical wounds.36, Moderate wound infections in immunocompromised patients and severe wound infections usually require parenteral antibiotics, with possible transition to oral agents.30,31 The choice of agent should be based on the potentially causative organism, history, and local antibiotic resistance patterns. Do this once a day until packing is gone. Care should be taken to avoid injecting anesthetic into the abscess cavity, as this will increase pressure (and thus pain for the patient) and is unlikely to successfully anesthetize. Cover the wound with a clean dry dressing. Penetrating wounds from bites or other materials may introduce other types of bacteria. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Your doctor will treat an MRSA abscess the same as another similar abscess by draining it and prescribing an appropriate antibiotic. Your wound does not start to heal after a few days. 7V`}QPX`CGo1,Xf&P[+_l H Then remove your bandage and cleanse the wound with soap and water 1-2 times daily. Bethesda, MD 20894, Web Policies You may also see pus draining from the site. Debridement can be performed using surgical techniques or topical agents that lead to enzymatic breakdown or autolysis of necrotic tissue.