Incision and drainage

Diagnosis

1. May use US or needle aspiration
2. Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing

Differential Diagnosis

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Treatment

1. Antibiotics
   1. Give if there is a large cellulitic component or fever, multiple sites, young or advanced age, abscess in area difficult to drain, associated septic phlebitis, and failure with I&D alone
   2. Need to cover staph and strep
   3. Preprocedure abx for pt with high risk cardiac lesions
2. Update Tetanus
3. MRSA decolonization for pts with recurrent skin infections
   1. Nasal mupirocin+chlorhexidine body wash+/-oral anti-MRSA abx for 5-10 days

Incision & Drainage

1. Be sure to document if packing was placed in the wound
2. Anesthesia should be lidocaine or Marcaine without epinephrine
3. Most patients need some pain medicine prior to procedure

• Beware of toxic dose of lidocaine!
• Lido lasts 30-90 min, bupivicaine (.25%) max= 2mg/kg lasts 6-8 hr. Do NOT inject bupivicaine intravascularly b/c= refractory cardiac arrest!!!

Follow-up

Wound check in 1-2 days and wound care sheet

See Also

• Lidocaine
• Bartholin Gland Abscess

Source

• Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18-e55
• Singer A, Talan D. Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047