This document describes the procedure for incision and drainage of an abscess. It outlines the objectives of relieving pressure and pain and draining pus/debris. Abscesses larger than 5mm in accessible areas are indications for the procedure. The incision should be made in the most dependent part of the swelling, parallel to skin lines. The abscess cavity is opened, locules are broken up, and the cavity is irrigated and may be packed or drained. Complications can include insufficient pain relief or progression to worsening cellulitis.

1. INCISION AND DRAINAGE
BY Dr.DONY DEVASIA,
ASSISTANT PROFESSOR, DEPARTMENT OF GENERAL SURGERY,
BELIEVERS CHURCH MEDICAL COLLEGE HOSPITAL.

2. OBJECTIVES:
• To drain pus along with bacterial toxins and other debris
• To relieve pressure effects and pain.
• To irrigate the cavity.
• To obtain fluid or pus for culture and sensitivity testing.
• Staphylococcus is the most common organism except in
perianal and perineal areas where coliforms and anerobes are
mostly responsible

4. INDICATIONS
• Abscesses more than 5 mms in size and found in
accessible location.
• Abscess has swelling,pain, redness, fluctuance.
• Needle aspiration could help confirm or a bed side
ultrasound could help in confirmation.

6. PRINCIPLES OF INCISION
PLACEMENT:
• Incision should be placed in most dependant area of
swelling and not on the centre most area.
• Parallel to the langers line. Resting lines within the skin
creases,
• sufficiently large enough to drain completely but
aesthetically acceptable also.
• Some practice cruciate incisions and deroofing of abscess
cavity.

8. SURGICAL PROCEDURE
• To attain anesthesia, either block the area or local infiltration in diamond shape.
• Incision placement
• Evacuation of pus , curved artery or listers forceps are used to break the loculi.Sent culture
and sensitivity
• Should be directed in all directions so that all locules are broken.
• Also finger can be inserted to break the locules.
• Irrigate the cavity with peroxide betadine+followed by normal saline to wash out to flush
necrotic debri or bacterial toxins until the flush is clear.
• Can put drain(corrugated rubber drain) or pack cavity with roller gauze so cavity is kept
opened and to keep walls of abcess separated and hemostasis is achieved,

10. HILTONS METHOD:
• In vital areas one method of incision and drainage near important structures.
• In Hilton method after skin incision through skin and subcutaneous tissue
only listers sinus forceps with closed beaks is inserted into deeper structures .
• Then beaks of listers sinus forceps are opened parallel to vital structues
and break locules.
when removing sinus forceps keep beaks opened so opening becomes larger.

11. • Supplementary antibiotics are needed if there is associated cellulitis or other
immunocompromised,fever or chills
• Make sure patients tetanus immunisations are up to date
• No benefit for topical antibiotics and are not needed.
• Packing removal to be done in 2 to 3 days.
• Follow up and packing removal earlier if there is any worsening.
• May need repacking.

12. COMPLICATIONS:
• Pain during procedure, insufficient anesthesia as tissue around an abscess is acidotic
and local anesthetic agents losses effect around acidotic tissue.Do field block
instead.
• Progression to cellulitis.
• Development of fever.
• Signs of clinical worsening.