Abscess incision and drainage in the emergency department-Part I

doi:10.1016/0736-4679(85)90077-0

The Journal of Emergency Medicine

Volume 3, Issue 3, 1985, Pages 227-232

https://doi.org/10.1016/0736-4679(85)90077-0 Get rights and content

Abstract

Superficial abscesses are commonly seen in the emergency department. In most cases, they can be adequately treated by the emergency physician without hospital admission. Treatment consists of surgical drainage with the addition of antibiotics in selected cases.

Incision is generally performed using local anesthesia, with introoperative and postoperative systemic analgesia. Care must be taken to make a surgically appropriate incision that allows adequate drainage without injuring important structures. Postoperative care includes warm soaks, drains or wicks, analgesia, and close follow-up. Antibiotics are usually unnecessary.

Complications of incision and drainage include damage to adjacent structures, bacteremic complications, misdiagnosis of such entities as mycotic aneurysms, and spread of infection owing to inadequate drainage.

The infectious agents responsible for abscess formation are numerous and depend largely on the anatomic location of the abscess. Staphylococcus aureus accounts for less than half of all cutaneous abscesses. Anaerobic bacteria are common etiologic agents in the perineum and account for the majority of all cutaneous abscesses.

Abscesses at specific locations involve special consideration for diagnosis and treatment and may require specialty consultation.

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Skin and soft tissue infections
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2010, Journal of Pediatric Surgery
The rising prevalence of community-acquired, methicillin-resistant Staphylococcus aureus (MRSA) has correlated with an escalating number of complex, subcutaneous abscesses in pediatric patients. The purpose of this study was to present a novel technique and early outcome results for the minimally invasive drainage of complex, subcutaneous abscesses.
Patients' outcomes from the treatment of complex, subcutaneous abscesses were retrospectively reviewed under institutional review board approval from July 2006 to August 2007 at 2 independent, tertiary care pediatric hospitals. Data on patients' demographics, length of hospital stay, and length of treatment were collected, along with analysis of the isolated organisms.
The operative technique uses drainage of the abscess through peripheral stab incisions. Cavity debridement and irrigation is followed by placement of a vessel-loop drain through the drainage incisions. Topical wound care without packing is performed twice a day. Drain removal follows resolution of cellulitis and drainage.
One hundred twenty-eight patients were treated over a 14-month period. The ratio of females to males was 1.25:1. Average patient age was 51.5 months (median, 21 months) and ranged from 5 weeks to 18 years. The average length of hospital stay was 1.5 days, though 30 patients were treated on an outpatient basis. Methicillin-resistant Staphylococcus aureus was identified in 76% of the cultured specimens. Average length of drain use was 9 days (range, 5-29 days). There were no local recurrences of subcutaneous abscesses. There was no morbidity related to the drainage procedures.
We present a successful technique for the drainage and treatment of complex abscesses in children with limited, postoperative wound care and no morbidity or recurrence.
Aspiration and Injection-Based Technique for Incision and Drainage of a Sacrococcygeal Pilonidal Abscess
2009, Journal of Emergency Medicine
Citation Excerpt :
We have described herein a reliable, effective, and, to our knowledge, novel resolution of this medical situation without using any systemic analgesics or sedatives. The concept of abscess puncture is not new and has been used for diagnostic purposes (9). Thus, needle aspiration of the most likely area of induration is recommended in cases of soft tissue abscesses to aid in diagnosis (3).
The incision and drainage of a sacrococcygeal abscess is a common procedure in the Emergency Department (ED) both to decrease a patient's pain and to improve the local wound conditions for subsequent definitive surgical therapy. However, the local infiltration of anesthetics is often problematic due to the unacceptable and unavoidable pain resulting from the injection itself, as well as the inability to achieve a complete anesthetic response. Therefore, standard textbooks generally recommend the concomitant use of local and systemic analgesics in the treatment of sacrococcygeal abscesses. We describe herein an alternative technique to administer local analgesia after the aspiration of an abscess for incision and drainage of a sacrococcygeal abscess that is safe and rapid. The patient is placed in the prone position and the buttocks are separated from the midline with adhesive tape. The technique involves needle aspiration of the abscess with consecutive slow injections of the same amount of local anesthetic into the abscess cavity via the same needle, followed by abscess drainage by incision and gentle curettage. This method therefore eliminates multiple infiltrations of the abscess and the surrounding area and obviates the associated pain due to the low volume of anesthetic required. The described technique is well tolerated by the patient and reduces the frequently encountered difficulty with incision and drainage of coccygeal abscesses in the ED.
Incision and Drainage
2008, Pediatric Emergency Medicine
Incision and Drainage
2007, Pediatric Emergency Medicine
Skin and Soft Tissue Infections
2006, Primary Care - Clinics in Office Practice
Citation Excerpt :
The incision should be deep enough to fully evacuate the fluid collection. In addition, loculations should be probed and broken up with the use of a hemostat if possible [17,18]. If there is any question about whether the patient is to be admitted, or if they have failed previous antibiotic therapy, a culture of the fluid should be obtained to help identify a causative organism.

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Abscess incision and drainage in the emergency department-Part I

Abstract

JACEP

JACEP

Ann Emerg Med

Lancet

Lancet

JACEP

Ann Emerg Med

Aerobic and anaerobic bacteriology of subcutaneous abscesses

Br J Surg

Pathologic Basis of Disease

Infections of the skin and soft tissues

Procedures and Techniques in Emergency Medicine

Surgical Gems. Surgical management of a superficial cutaneous abscess

J Derm Surg

Infections

Acute infections

A simplified method for the incision and drainage of abscesses

Am J Surg

New Instrument for office treatment of cyst and abscess of Bartholin's gland

JAMA