1. ABCESS INCISION AND DRAINAGE DR AFZAL JUNEJO ASSOCIATE PROFESSOR SURGERY LUMHS

2. DEFINITION Abcesses are localized infections of tissue marked by a collection of pus and surrounded by inflamed tissue. They may be found in any area of the body, but most present on the extremities, buttocks, breast, perianal area or from the base of a hair follicle. Abcesses begin when normal skin barrier is breached and microorganisms invade the underlying tissue and also in immunecompromised patients such as diabetes and chemotherapy patients.

3. INDICATIONS A fluctulant abcess on the skin that is papable It does not resolve with conservative measures, e.g. warm compress and antibiotics Causative organisms commonly include streptococcous, staphylococcus, enteric bacteria and gram – negative organisms

4. Extremely large abscesses which require extensive incision, debridement, or irrigation; they are best done in Operation room. Deep abscesses in very sensitive areas - supralevator, ischiorectal, perirectal - these require general anesthetic to obtain proper exposure Palmar space abscesses, or abscesses in the deep plantar spaces Abscesses in the nasolabial folds – they may drain to cavernous sinus and this area is known as dangerous area. intra abdominal abscesses and bone abscesses known as osteomilitis are difficult to treat.

5. MATERIALS Universal precautions materials i.e. gloves, surgical mask, surgical gown 2% lidocaine WITH epinephrine for local anesthesia, 10 cc syringe and 25 gauge needle for infiltration Skin prep solution ( pyodine) #11 scalpel blade with handle Draping Guaze Hemostat, scissors, packing Tape Culture swab

6. PROCEDURE Obtain informed consent Inform the patient of potential severe complications and their treatment Explain the steps of the procedure, including the not insignificant pain associated with anesthetic infiltration Explain necessity for follow-up, including packing change or removal

7. PROCEDURE CONTINUED Use universal precautions Cleanse site over abscess with skin prep Drape to create a sterile field Infiltrate local anesthetic, allow 2-3 minutes for anesthetic to take effect Incise widely over abscess with the #11 blade, cutting through the skin into the abscess cavity. Follow skin fold lines whenever able while making the incision

8. PROCEDURE CONTINUED Allow the pus to drain, using the gauzes to soak up drainage and blood. Use culture swab to take culture of abscess contents, swabbing inside the abscess cavity Use the hemostat to gently explore the abscess cavity to break up any loculations within the abscess Using the packing strip, pack the abscess cavity Place gauze dressing over wound, and tape in place

9. COMPLICATIONS AND MANAGEMENT ComplicationPreventionManagement Insufficient anesthesia Remember that the tissue around an abscess is acidotic, and local anesthetic loses effectiveness in acidotic tissues Do a field block; use sufficient quantity of anesthetic; allow time for anesthetic effect No drainageLocalize site of incision by palpation Extend incision deeper or wider as needed Drainage is sebaceous material Abscess was an inflamed sebaceous cyst Express all material, break up sac with hemostat, pack open as with an abscess

10. FOLLOW UP Arrange at least one follow up with the patient to check for proper healing