Incision and drainage
- Abscess of skin or superficial soft tissue
- No absolute contraindications
- Abscesses that may require OR management or specialist consultation include:
- Large or deep abscesses that are difficult to access or anesthetize
- Abscesses of the palms, soles, or nasolabial folds
- Areas in which cosmesis is important (face, breast)
- Local anesthetic
- Incision and Drainage Tray:
- Drape / towel
- Iodine swabs
|Agent||Without Epinephrine||With Epinephrine||Duration||Notes|
|Lidocaine||5 mg/kg (max 300mg)||7 mg/kg (max 500mg)||30-90 min||
|Mepivicaine||7 mg/kg||8 mg/kg|
|Bupivicaine||2.5 mg/kg (max 175mg)||3 mg/kg (max 225mg)||6-8 hr||
|Tetracaine||1 mg/kg||1.5 mg/kg||3hrs (10hrs with epi)|
|Procaine||7 mg/kg||10 mg/kg||30min (90min with epi)|
- Wound check in 1-2 days.
- Antibiotics only indicated if overlying cellulitis or evidence of systemic infection
- Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Abscess incision and drainage. N Engl J Med. 2007 Nov 8;357(19):e20.
- Fahimi J, Singh A, Frazee BW. The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. CJEM. 2015 Feb 20:1-13.
- 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