Incision and drainage

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Indications

  • Abscess of skin or superficial soft tissue

Contraindications

  • No absolute contraindications
  • Abscesses that may require OR management or specialist consultation include[1]:
    • 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)

Equipment Needed

  • PPE
  • Local anesthetic
  • Incision and Drainage Tray:
    • Scalpel
    • Hemostat
    • Forceps
    • Gauze
    • Drape / towel
    • Iodine swabs

Maximum Doses of Anesthetic Agents

Agent Without Epinephrine With Epinephrine Duration Notes
Lidocaine 5 mg/kg (max 300mg) 7 mg/kg (max 500mg) 30-90 min
  • 1% soln contains 10 mg/ml
  • 2% soln contains 20 mg/ml
Mepivicaine 7 mg/kg 8 mg/kg
Bupivicaine 2.5 mg/kg (max 175mg) 3 mg/kg (max 225mg) 6-8 hr
  • 0.5% soln contains 5 mg/ml
  • May cause cardiac arrest if injected intravascularly
  • Do not buffer with bicarbonate
Ropivacaine 3 mg/kg
Prilocaine 6 mg/kg
Tetracaine 1 mg/kg 1.5 mg/kg 3hrs (10hrs with epi)
Procaine 7 mg/kg 10 mg/kg 30min (90min with epi)

Procedure

Complications

Follow-up

  • Wound check in 1-2 days.
  • Antibiotics only indicated if overlying cellulitis or evidence of systemic infection[2], or for immunosuppressed patients or abscess that does not respond to standard treatment [3]

See Also

References

  1. Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Abscess incision and drainage. N Engl J Med. 2007 Nov 8;357(19):e20.
  2. 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.
  3. Singer A, Talan D. Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047
  • 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