• Incision and drainage are indicated when a large,
localized, and tender collection of pus occurs in the subcutaneous
tissues beneath the skin surface.
• When the diagnosis is unclear, needle aspiration may be diagnostic.
This is particularly helpful for deeper infections.
• Abscesses located in the deep tissues, the hand,
or the face.
• Lengthy or painful procedures in young children. Since these may
require conscious sedation, they should be performed only if resources
for conscious sedation are available.
• Abscesses requiring operative drainage and debridement. These
procedures should be performed in the operating area.
• Patients with underlying conditions that may complicate the healing
process or require close outpatient follow-up (eg, immunocompromised
state or diabetes). Referral to specialty clinics may be appropriate
for such patients.
• Sterile gloves.
• Povidone-iodine solution.
• Sterile gauze.
• Sterile dressing and drapes.
• Eutectic mixture of local anesthetics (EMLA/ELAMAX) or
1% lidocaine with epinephrine, or both.
• 25- or 27-gauge needle for lidocaine administration.
• #11 scalpel.
• Curved hemostats.
• Sterile packing material (iodoform gauze).
• Be careful not to mistake an abscess for a cellulitis
(a diffuse, suppurative inflammation). Needle aspiration can help
• Make the abscess incision large enough to permit adequate drainage
• For very small abscesses, the use of topical local anesthetic
ointment may be sufficient for drainage.
• Take a medical history. Children with cardiac valve disease should
receive antibiotic prophylaxis to prevent endocarditis.
• Apply topical local anesthetic (EMLA/ELAMAX)
over the abscess 30 minutes before the procedure. This provides
cutaneous anesthesia and often helps begin the drainage process.
• Put on mask, eye shield, and sterile gloves.
• Use lidocaine 1% with epinephrine for local anesthesia (Figure 41–1). Infiltrate the dermis
overlying the abscess in a linear distribution.
• Clean the area with povidone-iodine and set up
a sterile field.
• If you are uncertain about the definitive diagnosis of the abscess,
use an 18-gauge needle to aspirate the affected area.
• Using the #11 scalpel, make a linear incision through
the skin over the full length of the abscess cavity. Avoid proximate
• Allow the pus to drain from the cavity.
• Use a sterile gloved finger or hemostats to explore the cavity
and break up any loculations of pus.
• Place sterile packing material into the wound. Use a hemostat
to aid in the placement of the packing material (see Figure
• Leave an end of the packing material through the incision site
so that ...
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