Chapter 41

• • 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.

### Relative

• • 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).

• • Bleeding.

• Pain.

• Recurrence of the abscess due to inadequate drainage.

• • Be careful not to mistake an abscess for a cellulitis (a diffuse, suppurative inflammation). Needle aspiration can help distinguish them.

• Make the abscess incision large enough to permit adequate drainage of pus.

• 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.

• • Clean the area with povidone-iodine.

• Use lidocaine regionally for local anesthesia.

• • Place the patient in supine position for greatest comfort.

• • The anatomy varies depending on the location of the abscess.

• • 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 neurovascular structures.

• 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 41–1).

• Leave an end of the packing material through the incision site so that ...

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