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