Incision and Drainage of an abscess

Dr. Sherif Abou Bakr

Abscess Etiology
Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Pathogenesis
HOSTS HIGH CONCEN. INTACT SKIN MOIST ENV. OCCLUDE TRAUMA WOMEN IV DRUG USERS MANUAL LABOR CELLULITIS

NUTRIENTS

ABSCESS

LOCULATION OF PUS

LIQUIFY & ACCUM

NECROSIS

Bacteriology of Cutaneous Abscesses

Head, neck, extremities, trunk
Staphlocci Group a B-hemolytic streptococci

Buttocks and perirectal

Anaerobes

Perirectal area, head, fingers, and nailbed

Mixed aerobic and anerobic

Special Considerations
Parental drug users Insulin-dependent diabetics Hemodialysis patients Cancer patients Transplant recipients

Laboratory Findings
Offer no specific guidelines for therapy Not indicated Gram stain not indicated Routine culture not indicated
Except immunosuppressed

Indications and Contraindications

Incision and drainage is definitive treatment Antibiotics alone are ineffective Premature incision Heat Nonsurgical recheck <24-36 hours

Ancillary Antibiotic Therapy

Prophylactic Antibiotics
Endocarditis Bacteremia in other conditions

Therapeutic Antibiotics

Incision and Drainage Procedure

Procedure site Equipment and Anesthesia Incision Wound Dissection Wound Irrigation Packing and Dressing

Follow-up Care
Reevaluation 1-3 days (48 hours standard) Closely follow
Immunosuppressed Facial abscess

Instruct on wound care Decide on repacking Peroxide and Q-tips

Specific Abscess Therapy

Staphyloccal Disease Hidradenitis Suppurativa Breast Abscess Bartholin Gland Abscess Pilonidal Abscess Infected Sebaceous Cyst

Specific Abscess Therapy

Perirectal Abscess
Pathophysiology Epidemiology Physical and laboratory findings treatment

THANKS