Management of Severe Incisional Abscesses Following Laparotomy: Early Reclosure Under Cover of Metronidazole and Ampicillin

• Patients developing severe incisional abscesses following laparotomy were treated with incision and drainage followed by early reclosure under antibiotic cover with metronidazole and ampicillin anhydricum. Patients with subcutaneous abscesses were randomized into two groups that were treated with antibiotics for one day (n = 23) or four days (n = 27). These patients all underwent reclosure four days later. In a third group of patients (n=14) abscesses had developed down to, but not through, the peritoneum. These patients received antibiotic treatment for four days and underwent reclosure a mean of 5½ days later (range, four to eight days). No abscesses reappeared in any group and all wounds healed by first intention. Five patients healed totally, with minor defects, but there was no need for surgical intervention. We conclude that the early reclosure technique is a safe procedure under antibiotic cover with metronidazole and ampicillin. One day and four days of antibiotic treatment are equally safe in patients with subcutaneous abscesses. ( Arch Surg 1989;124:702-704)