Clean the area with providone-iodine or chlorhexidine.
Consult surgeon or other advanced provider
Determine optimal I&D technique
Consider culture for specific populations
Loosely pack abscess cavity to wound margins with sterile gauze, iodoform gauze, or silver-containing hydrofiber leaving 1 cm wick
Contraindications to epinephrine?
- Skin abscess
- Toxic appearance
- Mycotic abscesses
- Recurrent or extremely large abscess that would require the operating room
- Complex medical problems related to drainage or sedation
- Complex anatomical location (Breast abscess, perirectal abscess, Hand abscess, neck abscess likely involving a congenital cyst (thyroglossal, brachial, etc.), abscess in central triangle of face, other complex area (near vital artery, vein or other structure))
Risk for foreign body?
X-ray to identify radiopaque materials
Abscess >5 cm, Pilonidal abscess, Immunocompromised, diabetic?
Warm water soaks 3 times a day until healed
Will this abscess require incision and drainage?
Will abx be beneficial?
Contraindications to probiotics?
Probiotics
Endocarditis prophylaxis?
Will patient need tetanus prophylaxis?
Wound checks every 2 days with packing removal when purulent drainage stops
Warm compresses 4 times a day, follow up with PMD
Patient to require sedation?
Patient to benefit from regional nerve block?
Perform regional nerve block
1% lidocaine with epinephrine field block
1% lidocaine field block
Will patient benefit from antibiotics?
Contraindications to probiotics?
Probiotics
Probe the wound to release loculations and irrigate with copious amounts of tap water
Incision I&D
- Incise wound using 11 blade scalpel along the skin tension lines to the length of the abscess
Clindamycin or TMP-SMX + Cephalexin
Loop I&D
- Make small (5 mm) stab incision with 11 blade scalpel at one end of the abscess
- Insert hemostat, break up loculations, tent the skin on the opposite side of the abscess
- Make a small incision and push the hemostat through the skin
- Grasp a vessel loop with the hemostat, pull it through to the other side and tie a loose knot
- Patient to slide loop back-and-forth twice a day and apply warm compresses
- Remove loop 7-10 days later
Clindamycin or TMP-SMX + Cephalexin
Contraindications to lidocaine with epinephrine
- Peripheral vascular disease
- History of hypersensitivity to local anesthetics of the amide type
- Patient with disease process that make them susceptible to epinephrine (HTN, CV disease, etc.)
- Dirty or contaminated wounds
