med 18

 

2. Obtain blood cultures after drainage.

3. Do not suture abscess cavity following incision and

drainage.

4. Débride all tissue undergoing putrefaction and digestion thoroughly (3).

5. Make skin incisions:

a. Conform with skin creases/natural folds to minimize scar formation

b. Large enough to allow for proper débridement and

drainage

c. Simple linear–cruciate or elliptical skin incisions

may result in more unsightly scar formation (4).

6. For abscesses in cosmetic areas, areas under significant

skin tension (i.e., extensor surfaces), or areas with extensive scar tissue (i.e., sites of prior drainage procedures), a

stab incision or needle aspiration alone may be preferable.

(This may require multiple decompressions and/or

Chapter 48 ■ Drainage of Superficial Abscesses 355

delayed complete incision and drainage if reaccumulation

occurs.)

7. Care should be taken in areas with abundant vascular

and neural structures, such as the groin, posterior knee,

antecubital fossa, and neck (5).

8. If foreign body is suspected, a radiograph should be

obtained (4).

F. Technique (2–5)

1. Spray roof of abscess with ethyl chloride until skin

becomes white. (If local anesthesia is required, lidocaine can be injected subcutaneously with a 25-gauge

needle into the dome of the abscess.)

2. Prepare as for major procedure if abscess is to be

drained, or for minor procedure if needle aspiration

alone is to be performed (see Chapter 5).

3. Prepare local area with antiseptic (e.g., iodophor).

4. Aspiration (may be performed in combination with incision and drainage for confirmation of presence of pus

and collection of material for culture, or alone if abscess

is in area where incision is not preferable [see E6]).

a. Attach sterile needle to syringe.

b. Insert needle into pustule, abscess cavity, or advancing border of cellulitis.

c. Aspirate the material deep within the lesion.

d. If no material is aspirated, inject 0.1 to 0.2 mL of

nonbacteriostatic saline and withdraw immediately.

e. Process aspirated material immediately: Gram stain

and culture for anaerobic and aerobic organisms;

Giemsa stain for suspected herpes. Perform other

special stains as warranted.

5. Incision and drainage

a. Insert scalpel blade and incise at point of maximum

fluctuance. The size of the incision should be as

small as possible yet allow for continued adequate

drainage (i.e., length of the abscess cavity).

b. Obtain specimen for culture with cotton-tipped

applicator, if not obtained by prior aspiration with

syringe and needle.

c. Evacuate exudate from abscess with gentle pressure

from finger or hemostat wrapped in gauze. Use caution when probing abscess with finger in cases of

suspected retained foreign bodies or fragments—for

this reason, hemostat wrapped in gauze is the preferred method (4).

d. If necessary, insert mosquito hemostat into abscess

cavity and spread blades to break septa and to release

remaining collections of pus (Fig. 48.2A). Recognize

that this may cause discomfort and should be done

rapidly.

6. Lavage area with sterile saline to remove residual pus

(optional).