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ABSCESSINCISIONANDDRAINAGE

Abscesses are localized infections of tissue marked by a collection of pus


surroundedbyinflamedtissue.Abscessesmaybefoundinanyareaofthebody,butmost
abscessespresentingforurgentattentionarefoundontheextremities,buttocks,breast,
perianalarea,orfromahairfollicle.Abscessesbeginwhenthenormalskinbarrieris
breached, and microorganisms invade the underlying tissues. Causative organisms
commonlyinclude Streptococcus,Staphylococcus, entericbacteria(perianalabscesses),
oracombinationofanaerobicandgramnegativeorganisms.
Abscessresolvebydrainage.Smaller(<5mmindiameter)abscessesmayresolve
to conservative measures (warm soaks) to promote drainage. Larger abscesses will
requireincisiontodrainthem,astheincreasedinflammation,puscollection,andwalling
offoftheabscesscavitydiminishtheeffectivenessofconservativemeasures.

Indications

1.
Abscessontheskinwhichispalpable

Contraindications

1.
Extremelylargeabscesseswhichrequireextensiveincision,debridement,or
irrigation(bestdoneinOR)
2.
Deepabscessesinverysensitiveareas(supralevator,ischiorectal,perirectal)
whichrequireageneralanesthetictoobtainproperexposure
3.
Palmarspaceabscesses,orabscessesinthedeepplantarspaces
4.
Abscessesinthenasolabialfolds(maydraintosphenoidsinus,causinga
septicphlebitis)

Materials

1.
Universalprecautionsmaterials
2.
1%or2%lidocaineWITHepinephrineforlocalanesthesia,10ccsyringe
and25gaugeneedleforinfiltration
3.
Skinprepsolution
4.
#11scalpelbladewithhandle
5.
Draping
6.
Gauze
7.
Hemostat,scissors,packing(plainoriodoform,1/2)
8.
Tape
9.
Cultureswab

Preprocedureeducation

1.
Obtaininformedconsent
2.
Informthepatientofpotentialseverecomplicationsandtheirtreatment
3.
Explain the steps of the procedure, including the not insignificant pain
associatedwithanestheticinfiltration
4.
Explainnecessityforfollowup,includingpackingchangeorremoval

Procedure

1.
Useuniversalprecautions
2.
Cleansesiteoverabscesswithskinprep
3.
Drapetocreateasterilefield
4.
Infiltratelocalanesthetic,allow23minutesforanesthetictotakeeffect
5.
Incise widely over abscess with the #11 blade, cutting through the skin
(Figure1)intotheabscesscavity.Followskinfoldlineswheneverablewhile
makingtheincision

Figure1:Makingtheincision

6.
7.

8.

Allowthepustodrain,usingthegauzestosoakupdrainageandblood.Use
cultureswabtotakecultureofabscesscontents,swabbinginsidetheabscess
cavity
Use the hemostat to gently explore the abscess cavity to break up any
loculationswithintheabscess
Usingthepackingstrip,packtheabscesscavity(Figure2)


Figure2:Packingtheabscess

9.
Placegauzedressingoverwound,andtapeinplace

Complication
Prevention

Management

Insufficientanesthesia

Rememberthatthetissuearoundan Doafieldblock;usesufficient
abscessisacidotic,andlocal
quantityofanesthetic;allow
anestheticloseseffectivenessin
timeforanestheticeffect
acidotictissues

Nodrainage

Localizesiteofincisionbypalpation Extendincisiondeeperorwider
asneeded
Abscesswasaninflamedsebaceous Expressallmaterial,breakup
cyst
sacwithhemostat,packopenas
withanabscess

Drainageissebaceous
material