Understand: Incision & Drainage

This is a demonstration of a wound care physician performing an incision and drainage of a sample abscess. The demonstrator explains the techniques, instruments, indications and complications of this procedure. This demonstration is performed by a trained wound care physician for educational purposes only and should not be tried at home.

Understand Wound Care:
Incision & Drainage Demonstration
Commentary by Dr. Japa Volchok

This demonstration is a brief hands-on demonstration using a chicken breast model to demonstrate incision and drainage of an abscess. We will be demonstrating the technique, some of the commonly used instruments and discussing the indications and potential complications.

Several instruments that may be useful in incision and drainage of an abscess include a number 15 blade scalpel, as well as a suture removal kit with disposable scissors and forceps. In addition, a local anesthetic such as 1% lidocaine and appropriate syringe and needle will be necessary to adequately anesthetize the skin and underlying structures.

When performing an incision and drainage adequate anesthesia is necessary to relieve pain. An abscess cavity and environment is inherently acidic and anesthetic is not as effective as in a non-abscess area.

When performing an incision and drainage after adequate anesthesia has been achieved, and the skin has been cleansed with an anti-microbial agent, an approximately one centimeter to a half centimeter incision is made, at the pointing or most fluctuant area of the abscess. The fluid and pus is then expressed from the wound. The incision can be increased to adequately drain the abscess. It is more important that the incision in the skin and into the underlying subcutaneous space where the abscess has accumulated is of adequate size to produce drainage. Often it is indicated to place a small wick within the opening to prevent immediate re-closure of the skin as re-epithelialization can occur within 24 hours and the abscess can re-accumulate.

Abscesses of long duration often times have loculation or multiple pockets within the cavity. These will need to be broken up using a digit or in this particular demonstration, using scissors and forceps. Insert the scissors and spread circumferentially around the abscess cavity to break up any smaller pockets that are remaining. And, express any remaining pus.

An abscess frequently occurs when a superficial skin infection extends into the subcutaneous space and begins to accumulate with neutrophils and bacterial debris. This is essentially what is commonly known as pus.

Without adequate drainage of this space, the antibiotics that the patient may be placed on, do not reach the area where the bacteria are growing and the abscess can continue to extend and further propagate the infection.

Systemic antibiotics aren’t able to adequately treat an abscess and the abscess can only resolve with correct surgical drainage.

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