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[Video] How to do incision and Drainage of Abscess?

The process of  incision and drainage of an abscess is an important procedure in wound care management. According to research, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become an increasingly important cause of skin and soft tissue infections (SSTIs), particularly abscesses, in patients in the emergency department setting. The antibiotic sensitivity profile of Staphylococcus aureus isolated from SSTIs has changed over time in many geographic locations. Therefore, the efficacy of antibiotic therapy in treating skin abscesses due to Staphylococcus aureus is controversial. Instead, most abscesses can be treated with incision and drainage alone.

 

The diagnosis of cutaneous and subcutaneous abscesses is generally through physical examination. Simple abscesses can be treated with incision and drainage or needle aspiration for fluid collection in cosmetic areas.

This is a demonstration of a wound care physician performing an incision and drainage of a sample abscess. The demonstrator explains the techniques, instruments, indications and complications involved in carrying out i&d of an abscess. This demonstration is performed by a trained wound care physician for educational purposes only and should not be tried at home.

Understand Wound Care:
Incision & Drainage Demonstration
Commentary by Dr. Japa Volchok

This demonstration is a brief hands-on demonstration using a chicken breast model to demonstrate incision and drainage of an abscess. We will be demonstrating the technique, some of the commonly used instruments and discussing the indications and potential complications.

 

Several instruments that may be useful in incision and drainage of an abscess include a number 15 blade scalpel, as well as a suture removal kit with disposable scissors and forceps. In addition, a local anesthetic such as 1% lidocaine and appropriate syringe and needle will be necessary to adequately anesthetize the skin and underlying structures before carrying out an i&d of an abscess to avoid local pain.

When performing an incision and drainage of a simple abscess, adequate local anesthesia is necessary to relieve pain. An abscess cavity and environment are inherently acidic and local anesthesia is not as effective as in a non-abscess area. General anesthesia may be necessary to facilitate i&d of a larger and deeper abscess.

 

When performing an incision and drainage of an abscess after adequate anesthesia has been achieved, and the skin has been cleansed with an anti-microbial agent, an approximately one centimeter to a half-centimeter incision is made, at the pointing or most fluctuant area of the abscess. The fluid and pus are then expressed from the wound. The incision can be increased to adequately drain the abscess. It is more important than the incision in the skin, and into the underlying subcutaneous space where the abscess has accumulated, which is of adequate size to produce drainage. Often, it is indicated to place a small wick within the opening to prevent immediate re-closure of the skin as re-epithelialization can occur within 24 hours and the abscess can re-accumulate. Once the procedure is complete, the recovery time for the wound to completely heal will be around one to two weeks.

 

Abscesses of long duration often times have loculation or multiple pockets within the cavity. These will need to be broken up using a digit. In this particular demonstration of i&d of an abscess, scissors and forceps have been used. Insert the scissors and spread circumferentially around the abscess cavity to break up any smaller pockets that are remaining. And, express any remaining pus.

 

An abscess frequently occurs when a superficial skin infection or bacterial infection extends into the subcutaneous space and begins to accumulate with neutrophils and bacterial debris. This is essentially what is commonly known as pus.

 

Without adequate drainage of this space, the antibiotic therapy that the patient may be placed on to treat the bacterial infection may not prove to be effective. That’s because the medicines will not reach the area where the bacteria are growing, and the abscess can continue to extend and further propagate the infection.

 

While deciding the right course of action to drain a complex abscess, remember to avoid aggressive incisions in abscesses in cosmetic areas and areas with extensive scar tissue. Instead, it is better to use a stab incision or needle aspiration to limit the injury to the issue and the formation of a scar. However, multiple needle aspirations or ultrasound-guided needle aspirations may be needed to completely drain the fluid in some cases. 

 

If a non-complex abscess requires drainage, home care with a warm compress can help the abscess open up and drain. You can make warm compresses by wetting a washcloth with warm water. Place these warm soaks over the abscess for several minutes, a few times a day. However, do remember to wash your hands well before and after touching the wound to avoid infection.

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Author: Dr. Japa Volchok, DO

Dr. Volchok is the Vice President of Operations at Vohra Wound Physicians. Trained as a vascular and general surgeon he joined Vohra in 2009. Dr. Volchok is currently responsible for Vohra’s telemedicine program, legal and regulatory matters, and physician recruitment. He completed an executive management program at the Harvard Business School.

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