Written by Archana Fernando
Tuesday, 14 April 2009 22:57
Introduction to Incision and Drainage
Tip: Patients with anal
or perianal abscesses should also have an examination under
anaesthesia (EUA) - digital as well as with a rigid sigmoidoscope-
looking for fistula or any evidence of inflammatory bowel disease.
- I+D is the primary therapy for the management of
Most localized skin abscesses can be managed with
simple I+D and do not require antibiotics
General anaesthetic (GA) is required for large
abscesses requiring extensive incision, debridemenet or irrigation.
Also deep abscesses in sensitive areas (supralevator, ischiorectal,
perirectal) require GA for proper exposure
An appropriately consented and anaesthetized patient should be draped in order to expose the abscess.
If EUA is required then the patient should be placed in the lithotomy position.
- Incision - can be
elliptical or cruciate and should be made over the most fluctuant
point of the abscess.
Deroof abscess - remove
skin (and any necrotic tissue) in order to leave a hole overlying
Pus swab - take a swab
from deep within the abscess and send off for microscopy,
sensitivity and culture.
abscess cavity - use your finger or a
curette to break down all loculi and evacuate as much of the pus as
Irrigation - now you can
wash out the abscess cavity using a large amount of normal saline.
There is no evidence to support the use of one form of irrigation
solution over another. The important thing is to use lots of
Haemostasis - pressure
alone should stop any bleeding. If you can see an obvious point of
bleeding you can use diathermy.
Pack - loosely pack the
abscess cavity from the bottom up using kaltostat or gauze making
sure the opening in the skin remains wider than the base which
should allow it to granulate from the bottom up. There are not any
studies that compare different packing materials but loose packing
is important to avoid significant discomfort and difficulty in
Tip: The principles for performing I+D with
local anaesthesia are the same. The anaesthetic is most effective if
infiltrated in the skin overlying and surrounding the abscess rather
than directly into or under it.
Routine observation of heart rate, blood pressure and
The patient can go home the same evening or the next
Daily dressing change (by district nurse if necessary)
until the packs become dry
Antibiotics are not usually required. Treatment with
I+D alone leads to resolution without complications at the same rate
(>90%) as patients treated with I+D and antibiotics 1,2
Takes approximately 4 - 6 weeks to heal
- 1) A Hankin, L Everett et al. Are antibiotics
Necessary after Incision and Drainage of A Cutaneous Abscess?
Annals of Emergency Medicine. 2007; 6: 232-4
- 2) M Paydar, K J Hansen, F Charlebois et al.
Inappropriate Antibiotic Use In Soft Tissue Infections. Arch
Surgery. 2007; 141: 850-56