Vidradhi

abscess and its drainage

1. E mail : [email protected]

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3. •Abscess is the collection of pus, a thick,
yellowish fluid caused by bacterial,
protozoan, or fungal invasion of body
tissues.
•Abscesses can occur in the skin, in the
gums, in bone, and in body organs, such as
the liver, the lungs, and even the brain.
•The area surrounding the abscess becomes
red and swollen; sensations of pain and
localized heat are common.
•Treatment may involve surgical incision, the
use of antibiotics, or both.
OVER VIEW

4. DEFINITION
•The extremely deranged and
aggravated vayu, pitta, and kapha,
resorting to the bone and vitiating the
Tvaka (Skin), blood, flesh and fat of
person (with their own specific
properties) gradually give rise to deep
seated , painful round or extended
swelling which is called Vidradhi.

5. CLASSIFICATION
•Six type - vataja, pittaja,
kaphaja, sanipataika,
kshataja and asrikja .
•According to the site it is
divided into two type BAHYA
and ANTAH vidradhi.

6. SITES OF INTERNAL ABSECES
•Mouth of bladder
•About the umbilicus
•In the sides
•Kukshi (inguinal region)
•Vrikkas
•Liver
•Heart
•Kloma
•Spleen
•Rectum
•These are generally found to be seated at :-
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7. NIDANA
•Stale (kept overnight) ,very hot, dry (without
moisture and fat) dried up, those causing
primary sensation during digestion
•Lying on uneven bed, improper movements
of body parts.
•Internal Vidradhi :- Heavy incompatible and
uncongenial food, dry, putrid and
decomposed substances, excessive coitus
and fatigue physical exercise, voluntary
repression natural urges, eating of food
which is followed by an acid reaction

8. SAMPRAPTI

9. Aetiology
•The organisms gain entry to form
abscess by
–Direct infection from outside due to penetrating
wounds,
–Local extension from adjacent focus of infection,
–Lymphatic's,
–Blood stream or haematogenous.

10. Pathology
•The suppurative infection gradually leads to cell
death and liquefaction. Both, cells and exudates are
killed by the toxins of pyogenic organisms.
•Liquefaction of the dead tissue is caused by
proteolytic enzyme released from the dead
polymorphonuclear leucocytes.The resulting yellow
alkaline fluid is called “pus”.
•The surrounding pyogenic membrane consists of
dead tissue and a wall of granulation tissue.
•As recovery starts, this pyogenic membrane is
converted into fibrous tissue and the cavity is
gradually covered with granulation tissue which
transforms into collagen fibres

11. DOSHIC FEATURE
CHARACTERSTICS OF DISCHARGE

12. SANNIPATAJA VIDRADHI
KSHATAJA VIDRADHI
RAKTAJA VIDRADHI

13. SPECIFIC SYMPTOM OF INTERNAL
ABSCESS
 Guda – Supression of flatus.
 Bladder – Stangury.
 Umblicus – distress, hiccough, rumbling
in intestine.
 Flanks – aggravation of vayu.
 Vrikka – contraction in sides.
 Spleen – Dyspnoea.
 Heart – severe pricking pain.
 Liver – thirst, hiccough, dyspnoea.
Kloma – intolerable thirst.

14. CLASSIFICATION
•Pyogenic abscess :- it is the commonest
form of an abscess . Sub cutaneous, deep
or it can occur within liver or kidney etc.
•Pyaemic abscess :- It occurs due to
circulation of pyaemic emboli in blood
(pyaemia).
•Cold abscess :- Usually refer to tubercular
abscess either due to involvement of lymph
nodes or involvement of spine.

15. CLINICAL FEATURE
•Calor – Heat
•Ruber – Redness
•Dolar – Pain
•Tumor – Swelling
•Presence of Pus.
–Positive Fluctuation.
–Brawny edema, Pitting on
pressure.

16. PROGNOSIS
Su. Ni.9 / 23
Su.su.33
 Curable
 doshic abscess with less complication
 internal abscess presents as external sinus.
Difficult to cure.
 abscess at marma
 int abscess above umbilicus which burst and pus
come out through mouth.
int abscess below umbilicus which burst and pus come
out through anus.
Incurable
 sannipataja vidradhi.
Abscess at heart, umbilicus, bladder.
Abscess with complication like – obstruction of flatus
& faces, urine, vomitting, dehydration, hiccough,
dyspnoea.

17. GLUMA Vs VIDRADHI
VIDRADHI GULMA
Originates from deranged
organic matter such as
skin, flesh, blood (Dushya)
Does not involve dusya
meaning it never
originates from any Dhatu.
In the pathogenesis of
vidradhi deranged dosha
affects the dhatu & causes
a swelling later it
suppurates.
In gluma dosha itself get
accumulated in a cavity
(Kostha) & causes a
pseudo swelling.
In vidradhi the dusya like
Twak, Rakta get
suppurated or liquification
of tissue are seen
In gluma due to the
absence of dusya it never
suppurates

18. GENERAL TREATMENT
 Ekadasha karma during amavastha.
 Darana karma in sensitive patients by
using darana dravya like –Chiraavilwa,
Langali, Danti, Chitraka etc.
 Bhedana karma by Vridhipatra,
Nakhasastra, Mudrika, Utpalapatraka
by avoiding sira snayu & marma

19. VATAJA VIDRADHI
 Before suppuration
 Bhadra darvyadigana paste mixed with clarified
butter, oil, vasa may be applied by making luke
warm.
 flesh of aquatic animal boiled with kakolyadigana,
kanjika, salt and clarified butter may be applied.
 contineous fomentation of vesavara, krisara, milk.
 After suppuration
 Incised by knife
 cleaned by panchamula kasaya.
 Oil cooked with Bhadradarvyadigana, Yasthimadhu
& Salt may be used for packing & dressing.iuÉaë£ëaü
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SPECIFIC
TREATMENT

20. PITTAJA VIDRADHI
 Before suppuration
 paste composed of sugar, fried paddy,
yasthimadhu & sariva may be applied with milk.
Paste of Payasa, Ushira, Chandana & Milk.
 Yavakshara, sugar cane juice, milk & Jivaniya
Ghrita
 leech application
 After suppuration
 Incision with Utpalapatraka.
 cleaned by Kshiri vriksha kasaya.
 Poultice of sesamum, Yasthimadhu, Honey &
Butter or Karanjadi Ghrita may be used for packing
& dressing.iuÉaë£ëaü
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SPECIFIC
TREATMENT

21. KAPHAJA VIDRADHI
 Before suppuration
 Softened by applying heat with hot brick,
iron, cow dunk, urine etc.
 Blood letting by Alabu application
 After suppuration
 Incision with Utpalapatraka.
 cleaned by Aragvadha kasaya.
 Poultice of sesamum, Haridra, Trivrit,
Saktu & Honey may be used for packing
& dressing.iuÉaë£ëaü
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SPECIFIC
TREATMENT

22. Before suppuration
 Rest, Elevation of the part,
Antibiotics.
 After suppuration
 Incision & Drainage

23.  Anaesthesia – Superficial abscess
may be drained by superficial
anaesthesia (Ethyl chloride spray).
Deep abscess requirs general
anaesthesia.
 Incision
 Free or Liberal Incision
 Hilton’s Incision
 Exploration
 Counter incision
 Drainage

24. Where there is pus, let it out..
•Principle of treatment of an abscess is:
–To drain pus,
–To send a sample of the pus for C/S
–To give proper antibiotic.
•Drainage by Liberal(free) incision or by Hilton’s
method.
•When the presence of abscess is obvious, do not
rely on antibiotic only.
•Administration of antibiotic continuously may lead
to chronicity & form a hard lump, known as
“antibioma”. Avoid: “beating around the bush”.

25. Free incision
•The incision is made on the most prominent
part so as to cause least damage to the
surrounding healthy tissue and on the most
dependent part so that the gravity will help
drainage.
•Incision must be adequate for easy drainage
of pus and to avoid chronicity.
•If there is any important underlying structure
(nerve/vessel), the incision should be made
parallel to those structures.
•Muscle should be incised along the line of
fibers.

26. Exploration
•After the incision has been made upto
the pus cavity and the pus has been
extruded, a finger is inserted into the
abscess cavity and all the walls of the
loculi are broken.
•There must not be any loculi
unbroken, as this will to chronicity.

27. Counter-incision
•When the most prominent part is not the most
dependant part, complete evacuation of the
abscess cavity is not possible.
•So, a counter incision is required at the most
dependant part to facilitate drainage by
gravity.
•Through the first-incision made on the most
prominent part, an artery forceps is pushed to
the most dependant part.
•The blades are slightly made apart, then with
a knife a fresh incision is made on the skin
between the tips of the artery forceps.

28. Closure
•After the pus has been thoroughly drained, a
roller gauze is packed inside the wound.
•There is always bleeding from the surrounding
granulation tissue.
•If the bleeding is slight, the roller gauze is taken
out, but, if the bleeding is troublesome, it can be
kept for 48 hours, after which it is replaced by by
simple corrugated rubber sheet drain.
•Proper systemic antibiotic should be started as
early as possible.
•Some surgeons believe in local antibiotic, but its
place is still controversial.

29. Follow-up
•After 48 hours, the dressing is removed.
•Fresh dressing is done everyday with acriflavine
lotion and sterile gauze.
•If required, proper local antibiotic may be used.
•Rest to the affected part is very important.
•Vitamins should be given to the subjects, who are
thought to be suffering from this deficit.
•Vitamin C should be given to all cases – 500mg
tab OD, as this helps in wound healing.
•Vitamin B complex should always be given with
tetracycline when this antibiotic is the choice.

30. Hilton’s method
•This method is chosen when there are plenty of
important structures like nerves and vessels
around the abscess cavity.
•The skin and subcutaneous tissue are incised.
•A pair of artery forceps or sinus forceps is
insinuated through the deep fascia into the
abscess cavity.
•The blades are now gradually opened and the
pus is seen extruding out.
•The forcep is taken out with the jaws open to
increase the opening.
•Now, a finger is introduced to explore properly as
described above.

31. Post op measure
 Rest to the part.
 antibiotics – preferably by c/s.
 Regular dressing, Gradual
lighter packing.
 NSAID.

32. SOME COMMON ABSCESS
 Neck abscess.
 Axillary abscess.
 Inguinal abscess.
 Poplitial abscess.
 Gluteal abscess.
 Illiac abscess.
 Thigh abscess.
 Deltoid abscess.

33. THE OPERATIVES

ON
DIFF. ABSCESSES

34. Abscess of the neck
•This usually results from suppuration of the
regional lymph nodes.
•It may occur from extension of alveolar
abscess.
•For cosmetic reason, horizontal incision
along the natural crease is preferred.
•Only when the abscess runs along the
direction of the sternomastoid, an incision
along its anterior border is made.
•The abscess is drained by Hilton’s method.

35. Abscess of the axilla
•This abscess is caused by suppurative lymphadenitis.
•Sometimes, axillary abscess may occur from boils
affecting many hair follicles or sweat glands.
•With fully abducted arm the incision is made ½ an inch
behind the anterior fold of axilla to avoid the major vessels
and nerves.
•At this place, there is no important structure.
•Moreover, the pus is usually located behind the pectoralis
major muscle.
•Drainage of the pus is done by Hilton’s method.

36. Abscess of the groin
•Such abscess occur as suppurative condition of the
inguinal lymph nodes.
–The medial group of horizontal lymph nodes is involved from
infection of the external genitalia,
–The vertical group is involved from infection of the lower
limb.
•Incision:
–For the medial group of lymph nodes, a transverse incision
along the most prominent and dependent part of the
abscess cavity is made.
–For the vertical group, a vertical incision along the abscess
is preferred parallel to femoral vessels so as to protect these
vessels. An added advantage of this incision is that the
wound is likely to gape when thigh is bent, thus providing
better drainage.

37. Popliteal abscess
•This abscess is caused by 3 conditions:
–Suppuration of the regional lymph nodes,
–Osteomyelitis of the lower end of femur or upper
end of tibia,
–Infection of the local cellular tissue.
•Incision:
–It is made slightly medial to the lateral border of
the popliteal space parallel to the biceps tendon.
–Obviously, this incision is on the lateral on the
popliteal space.
–Care must be taken not to injure the lateral
popliteal nerve.

38. Gluteal abscess
•This abscess is often caused by infection
of a haematoma.
•Intragluteal injection in the form of
intramuscular administration of various
drugs may cause gluteal abscess.
•Quinine injection is a common cause.
•Incision:
–A free incision is made over the most prominent
and dependant part of the gluteus maximus
(downwards & laterally).
–Counter incision may not be required.

39. Iliac abscess
•It is also due to infection of a haematoma within
the iliac muscle.
•Clinically, it mimics very closely to an
appendicular abscess.
•But, it is slightly lateral to the usual position of
appendicular abscess.
•Moreover, Rovsing’s sign is absent here.
•Incision:
–It is made just above & parallel to the iliac crest.
–The structures are cut right up to the abscess cavity along
the line of incision.
–Care must be taken not to open the peritoneal cavity, as it
is obliterated by adhesion’s.

40. Deltoid abscess
•Such abscess is usually caused by
infection of haematoma or
intramuscular injection.
•Incision:
–A free longitudinal incision is made over the most
prominent part of the abscess in the direction of
the deltoid muscle fibres.
–A counter incision at the most dependant part
sometimes becomes necessary.

41. Abscess of the sole & heel
•Such abscess usually caused by prick of a thorn or
a needle or secondary to acute osteomyelitis of the
calcaneum.
•Incision:
–A free incision is made on the most prominent part of
the swelling along the lateral or medial margin of the
sole.
–So, scar from healing of drainage wound remains
away from the weight bearing areas.
–Sometimes, such abscess is a ‘collar stud’ - one with
superficial & deep parts connected through a small
nick in the plantar fascia.
–So, care must be taken to drain the deep part as well
as by extending incision on the plantar fascia.

42. BREAST ABSCESS

43. AXILLARY ABSCESS

44. GLUTEAL ABSCESS