Incision and drainage

Dr.DONY DEVASIA{GENERAL AND LAPAROSCOPIC SURGEON}

1. INCISION AND DRAINAGE BY Dr.DONY DEVASIA, ASSISTANT PROFESSOR, DEPARTMENT OF GENERAL SURGERY, BELIEVERS CHURCH MEDICAL COLLEGE HOSPITAL.

2. objectives: To drain pus along with bacterial toxins and other debris To relieve pressure effects and pain. To irrigate the cavity. To obtain fluid or pus for culture and sensitivity testing. Staphylococcus is the most common organism except in perianal and perineal areas where coliforms and anerobes are mostly responsible

3. indications Abscesses more than 5 mms in size and found in accessible location. Abscess has swelling,pain , redness, fluctuance. Needle aspiration could help confirm or a bed side ultrasound could help in confirmation.

4. Principles of incision placement: Incision should be placed in most dependant area of swelling and not on the centre most area. Parallel to the langers line. Resting lines within the skin creases, sufficiently large enough to drain completely but aesthetically acceptable also. Some practice cruciate incisions and deroofing of abscess cavity.

5. Surgical procedure To attain anesthesia, either block the area or local infiltration in diamond shape. Incision placement Evacuation of pus , curved artery or listers forceps are used to break the loculi.Sent culture and sensitivity Should be directed in all directions so that all locules are broken. Also finger can be inserted to break the locules. Irrigate the cavity with peroxide betadine+followed by normal saline to wash out to flush necrotic debri or bacterial toxins until the flush is clear. Can put drain(corrugated rubber drain) or pack cavity with roller gauze so cavity is kept opened and to keep walls of abcess separated and hemostasis is achieved,

6. Hiltons method: In vital areas one method of incision and drainage near important structures. In Hilton method after skin incision through skin and subcutaneous tissue only listers sinus forceps with closed beaks is inserted into deeper structures . Then beaks of listers sinus forceps are opened parallel to vital structues and break locules. when removing sinus forceps keep beaks opened so opening becomes larger.

7. Supplementary antibiotics are needed if there is associated cellulitis or other immunocompromised,fever or chills Make sure patients tetanus immunisations are up to date No benefit for topical antibiotics and are not needed. Packing removal to be done in 2 to 3 days. Follow up and packing removal earlier if there is any worsening. May need repacking.

8. Complications: Pain during procedure, insufficient anesthesia as tissue around an abscess is acidotic and local anesthetic agents losses effect around acidotic tissue.Do field block instead. Progression to cellulitis. Development of fever. Signs of clinical worsening.