Incision and Drainage of an Abscess by Sherif Abou Bakr

Incision and Drainage of an abscess

Dr. Sherif Abou Bakr

Abscess Etiology

• Staphylococcal strains

• Group A B-hemolytic streptoccal

• Anaerobic bacterial

Pathogenesis

INTACT SKIN

HIGHCONCEN. OCCLUDE

MOISTENV.

NUTRIENTS

TRAUMA

HOSTS

MANUAL LABOR

WOMEN

IV DRUG USERS

CELLULITIS

NECROSISLIQUIFY&

ACCUM

ABSCESS LOCULATIONOF PUS

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