incision and drainage of an abscess by sherif abou bakr
TRANSCRIPT
Incision and Drainage of an abscess
Dr. Sherif Abou Bakr
Abscess Etiology
• Staphylococcal strains
• Group A B-hemolytic streptoccal
• Anaerobic bacterial
Pathogenesis
INTACT SKIN
HIGHCONCEN. OCCLUDE
MOISTENV.
NUTRIENTS
TRAUMA
HOSTS
MANUAL LABOR
WOMEN
IV DRUG USERS
CELLULITIS
NECROSISLIQUIFY&
ACCUM
ABSCESS LOCULATIONOF PUS
Bacteriology of Cutaneous Abscesses
• Head, neck, extremities, trunk– Staphlocci– Group a B-hemolytic streptococci
• Buttocks and perirectal– Anaerobes
• Perirectal area, head, fingers, and nailbed– Mixed aerobic and anerobic
Special Considerations
• Parental drug users
• Insulin-dependent diabetics
• Hemodialysis patients
• Cancer patients
• Transplant recipients
Laboratory Findings
• Offer no specific guidelines for therapy
• Not indicated
• Gram stain not indicated
• Routine culture not indicated– Except immunosuppressed
Indications and Contraindications
• Incision and drainage is definitive treatment
• Antibiotics alone are ineffective
• Premature incision
• Heat
• Nonsurgical recheck <24-36 hours
Ancillary Antibiotic Therapy
• Prophylactic Antibiotics– Endocarditis– Bacteremia in other conditions
• Therapeutic Antibiotics
Incision and Drainage Procedure
• Procedure site• Equipment and
Anesthesia• Incision• Wound Dissection• Wound Irrigation• Packing and Dressing
Follow-up Care
• Reevaluation 1-3 days (48 hours standard)
• Closely follow– Immunosuppressed– Facial abscess
• Instruct on wound care
• Decide on repacking
• Peroxide and Q-tips
Specific Abscess Therapy
• Staphyloccal Disease• Hidradenitis
Suppurativa• Breast Abscess• Bartholin Gland
Abscess• Pilonidal Abscess• Infected Sebaceous
Cyst
Specific Abscess Therapy
• Perirectal Abscess– Pathophysiology
– Epidemiology
– Physical and laboratory findings
– treatment
THANKS