This document discusses different types of abscesses and their treatment. There are three main types: pyogenic, pyaemic, and cold abscesses. Pyogenic abscesses result from bacterial infections and can develop from cellulitis or lymphadenitis. Treatment involves incision and drainage if pus is present. Pyaemic abscesses are caused by infectious emboli spreading through the bloodstream and result in multiple abscesses. Cold abscesses are typically tuberculous in nature and develop in lymph nodes or bones. Complete excision or drainage with antitubercular drugs is the treatment.

1. DR. GAURAV SANGAM

2. DEFINATION:
• An abscess is a collection of pus that has built
up within the tissue of the body.
• An abscess is a circumscribed area of
inflammation or an abnormal cavity that
contains pus if matured.

3. TYPES:
•There are 3 types of abscess:
•1. Pyogenic abscess
•2. Pyaemic abscess
•3. Cold abscess

4. PYOGENIC ABSCESS
• This is a collection of pus, resulting from
infection by Pyogenic organisms.

5. ENTRY OF ORGANISMS:
1. Direct infection from outside due
to penetrating wound
2. Local exension from adjacent focus
of infection
3. Lymphatics
4. Blood stream or haematogenous

6. Infection of pyogenic
organisms
Pus formed by
liquefaction of tissues
(caused by proteolytic
enzyme)
Leads to death and
liquefaction

7. • Commonest precursors of pyogenic
abscess:
 Cellulitis
 Acute lymphadenitis

8. FATE
• Tension inside the abscess cavity
gradullay rises owing to exudation
of plasma, and the abscess spreads
along the paths of least resistance
i. The surface of the body
ii. A hollow viscus, into which it ruptures.

9. FATE
2.
Body resistance, aided by antibiotics
Kills bacteria before the abscess finds its
way to the surface
Fibrosis
occur
Fluids is then gradually reabsorbed
Cavity persists
and contains
thick,sterile
pus
(antibioma)

10. CLINICAL FREATURES:
1. Features of acute inflammation are present
I. Calor
II. Rubor
III. Dolor
IV. Tumor
2. Presence of pus is elected by:
I. For superficial pus - Fluctuation
II. For deep seated pus - Brawny edema, pitting
under pressure, with induration
3. Fever

11. FEW OF THE PYOGENIC ABSCESS
1. Axillary abscess
2. Inguinal abscess
3. Popliteal abscess
4. Gluteal abscess
5. Thigh abscess
6. Deltoid abscess
7. Sole abscess / Heel abscess

12. Treatment in pyogenic abscess
• In early cases – where pus is still to form
I. Conservative management
II. Rest and elevation of the part
III. Antibiotic cover
• As presence of pus is diagnosed
I. Incision and drainage

13. PYAEMIC ABSCESS:
• Pyaemic absceses, caused by
infective emboli in cases of pyaemia.
• Pyaemia is a condition in which infective emboli,
consisting of clumps of organisms, infected
clots, or vegetation, circulate in the blood
stream.
( In conditions like acute osteomyelitis, infected compound fracture,
acute inflammation of an intracranial sinus.)

14. FEATURES:
• They are multiple
Can occur
on
Is fatal if
present in
brain and
heart
The surface ,
commonly on
subfascial plane
Present as swelling
In viscera like
spleen and
kidney
Non reacting
Little pain
Little or no sign
of inflammation

15. TREATMENT OF PYAEMIC ABSCESS:
I. Identify the source, if
detectable
II. Antibiotics preferably
choosen by culture
sensitivity test
III.Incision and drainage

16. COLD ABSCESS
• These denote tuberculous abscess
• Most commonly arising in lymph
nodes, bones or joints
• Non reacting, with no cardinal
features of acute inflammation
(sometimes present)

18. HOW TO DIAGNOSE?
• Are diagnosed by their characteristic
positions where important sets of nodes are
present
Eg- neck, axilla, groin
• On palpation – characteristic features of
tuberculous lymphadenitis, i.e soft and
matted nodes
• Cold abscess have tendency to travel to long
distances along definite anatomical planes
(Tracing nerve, sometimes vessels)

19. SPECIAL INVESTIGATIONS
1. Blood examination
2. X-ray chest
3. Mantoux text
4. ELISA test
5. Aspiraion – culture sensitivity

20. TREATMENT OF COLD ABSCESS
1. Full Anti-tuberculosis treatment
2. Treatment for primary focus
3. For abscess itself –
i. Repeated aspiration with local
instillation of INH (Isoniazid) solution
ii. Complete excision of the abscess with its
wall, together with focus origin
Eg- group of nodes3

21. Incision and Drainage
A. Anesthesia
B. Incison
i. Free or Liberal Incision
ii. Hilton’s Method
C. Exploration
D. Counter-incision
E. Drainage
F. Post Opeartive Care

22. A. Anesthesia
• Superficial abscesses may be drained
with surface anesthesia
• Deep abscesses require General
Anesthesia
(LA might spread infection to
neighbouring tissues)

23. B. Incision:
Free/Liberal Incision:
• Made on mostly prominent part
• It causes minimum damage to the
surrounding healthy tissue
 Principle of incision –
• Should ensure adequate drainage
• Parallel to important vessels, nerves, tendons
• Muscle should be incisied along the line of
fibers

24. Incision
Hiltons method:
• Chosen when there are plenty of
important structures like nerves and
vessels
• Employed in places like neck, axilla, groin

25. Incision in Hiltons Method:
Skin and
subcutaneous
tissue are incisied
On most prominent
part/ most
dependent part
Forcep is taken out
with jaws open
A finger is
introduced to
explore the abscess
cavity
Artery
forcep/Sinus
forcep forced in
cavity through
deep fascia
Blades are
gradually open and
pus drained

26. C. Exploration
• A fnger is introduced into the
abscess cavity
I. To define its limit
II. To break any septum inside, thus
making all loculi into one cavity,
for complete drainage

28. 4. Counter incision
1. Abscess will drain better if there is counter
incision
2. Where original incision is not the most
dependent part, here counter incision helps in
draining cavity
3. A sinus forcep passed in cavity till most
dependent part, a small nick is made on the
skin over the forceps to make the counter
opening

30. E. Drainage:
• A corrugated rain or wick of gauze
• Where walls of abscess is very
vascular, a tight packing of the cavity
is required to achieve hemostasis

32. F. Post opeartive care
1. Rest to the part
2. Antibiotics preferably chosen by
culture sensitivity test
3. Regular dressing – if the cavity has
been packed, the packing should
4. Drains are removed after 48hrs

33. Cruciate Incision:

34. Blades and handle
• Handles :
• 3 & 4 : shorter and wider
• 5 & 7 : longer but breadth is less
• Blades :
• 11 – stab incisions (drainage of abscess)
• 15 – plastic surgery, pediatric surgery
• 23 – skin and deeper incision
Handle Blade
3 11 & 15
4 22

37. •THANK YOU…..