INCISION AND DRAINAGE

Dr Rao Ijaz Khalid

House Surgeon
 CONTENTS

• What Is abscess?
• Etiology
• Introduction to Incision and Drainage
• Procedure
 CASE SCENARIO

• A previously healthy 28 year old male presents with painful swelling on back of his hand 3 days
back . On examination there is 2×3cm fluctuant, tender ,erythematous mass. Patient is afebrile
with vital signs in normal limits.

• What is your provisional diagnosis?

• How will you treat it?
 ABSCESS

• An Abscess is a circumscribed area of inflammation or abnormal cavity that contains pus.

• Pus: Thick liquid produced in infected tissue consisting of dead white blood cells and bacteria
with tissue debris and serum.
• The process of formation of pus is called suppuration.
 ETIOLOGY

• The main causes of abcess are pyogenic bacterias like

• Streptococcus bacteria
• Staphylococcus bacteria
• Pseudomonas aeruginosa
• Actinomyces bovis
• Actinobacillus lignueressi
 TREATMENT OF AN ABSCESS

• Smaller abscesses less than 5mm may resolve spontaneously with application or warm
compresses and antibiotics.
• Larger Abscesses greater than 5mm will require incision and drainage as a result of increased
collection of pus, inflammation and formation of abscess cavity which lessens the success of
conservative measures.
• Untreated abscesses can rupture spontaneously and drain or may extend deep into the
subcutaneous tissue followed by sloughing and extensive scarring.
 INDICATIONS OF INCISION AND DRAINAGE

• Palpable and Fluctuant Abscess

• An abscess that does not resolves despite conservative measures
• Large Abscess greater that 5mm
 CONTRAINDICATIONS
OF INCISION AND DRAINAGE
• Extensively Large or deep abscess that may require surgical debridement and general Anesthesia.
• Facial abscesses in the nasolabial folds(risk of septic phlebitis secondary to abscess drainage into
the sphenoid sinus)
• Hand and finger abscesses should receive orthopedic consultation.
THE PROCEDURE
.
 INCISION AND DRAINAGE
EQUIPMENT
• Universal Precaution materials(Gown, Gloves, Protective eyewear)
• Sterile draping towels and sterile gloves.
• Local anesthetic (2% lidocaine with or without Adrenaline)
• 10cc Syringe
• Skin Preparatory materials (Chlorhexidine or other antimicrobial disinfectant swabs)
• Blade And Scalpel
• Curved Hemostats
• Scissors
• Packing ribbon gauze
• Dressing
 STEP 1
PREPARE THE SURFACE
• Prepare the surface of the abscess and surrounding skin with disinfectant solution and drape the
abscess with sterile towels. Perform a field block by infiltrating local anesthetic around and under
the tissue surrounding abscess.
• Things to remember:
1. The environment of abscess is acidic, which may cause local anesthetic to
lose effectiveness. Make sure to give appropriate amount of anesthesia and adequate time for effect.
2. Avoid injecting in the abscess cavity, because it may rupture downward into
the underlying tissues or upward toward the care provider.
 STEP 2
MAKING AN INCISION
• Make a linear incision with blade no. 11 or 15 into the abscess.
• Things to Remember:
1. The most common cause of abscess recurrence is an incision is not wide
enough to promote adequate drainage.
2. Contents of the abscess may project upward and outward when it is
incised, especially if local anesthetic was inadvertent injected into (instead of around) the abscess.
Use personal protective equipment to avoid self contamination.
 STEP 3
DRAINAGE
• Allow purulent material from abscess to drain. Gently probe the abscess with curved hemostats
to breakup loculations. Attempt to manually express purulent material from the abscess.
• Remember to pierce secondary pockets by blunt dissection without damaging vessels and nerves.
 STEP 4
PACKING
• Insert Packing material into the abscess with hemostats or forceps. Dress the wound with sterile
gauze and tape.
 COMPLICATIONS

1. Recurrence (Make sure to remove all pus and clean the wound extensively with full aseptic
measures)
2. Septic Thrombophlebitis
3. Necrotizing Fascitis
 POST PROCEDURE CARE

• Counsel the patient that a scarring is possible.

• Wash wound daily and change dressing with aseptic measures. Cut the gauze smaller according
to the size of cavity.
• Prescribe Antibiotic accordingly and analgesics accordingly.