View source for Abscess Incision and Drainage (I&D)

Small abscesses may be drained via needle decompression however most abscesses seen in the emergency room benefit from scalpel incision and drainage. 

*Although incision and drainage is not a sterile procedure and does not require sterile technique, typically skin is cleansed with chlorhexidine or povidone-iodine prior to placement of a field block with lidocaine or bupivacaine (step A in image). 
*Use a scalpel with a #11 blade to make an incision into the abscess pocket and loculations are bluntly dissected with forceps or wound probe (step B-D). 
*While small abscesses may be allowed to drain on their own, most abscesses warranting I&D benefit from packing with either plain gauze, iodoform gauze or a drain (step E). 
*Large abscesses may require two incisions to be made and placement of a through Dermastent or penrose drain. 
*''All purulent drainage should be sent for wound culture to guide antibiotic therapy.''
*Per YKHC guidelines abscesses with >/= 10 cm of cellulitis should be covered with antibiotics. 
*If there is concern for deep abscesses formal or bedside US may assist in evaluation.

===Resources/References===
* Fitch et al. [https://www.nejm.org/doi/full/10.1056/NEJMvcm071319 Abscess Incision and Drainage] N Engl J Med 2007; 357:e20. DOI: 10.1056/NEJMvcm071319
* [[Skin and Soft Tissue Infection]] (YKHC Common/Unique Diagnoses)
* [[media:SSTI.pdf|Skin and Soft Tissue Infection YKHC Clinical Guideline]]


[[Common ED Procedures]]
<br/>[[Clinic Appointments/Encounters#Procedures|Common Outpatient Procedures]]