Abscess

Abscess

(Incision and Drainage of Abscess)

Introduction to Procedure

We know that undergoing any procedure is a scary experience.  We understand the worry and anxiousness that is associated with surgeries and procedures and aim to walk the road to recovery with you every step of the way. We put this information together using the very helpful handbook, ‘Handbook of Surgical Consent” from Rajesh Nair and David J. Holroyd.  We hope that the following information will answer all your questions and help you with the preparation phase for your procedure.

Description of procedure

An abscess is a collection of pus that has accumulated in a cavity as a result of an infective process. It is a part of the host defence response to prevent the spread of sepsis systemically. Abscesses tend to present with local symptoms of pain, swelling, redness and limitation of movement. Systemic symptoms, which include pyrexia, are not uncommon. The most common organisms involved are Staphylococcus aureus and Streptococcus. Surgical treatment is with incision and drainage of the sepsis, and those with weakened immune systems, e.g. patients on steroids or chemotherapy and patients with diabetes, renal failure on dialysis, or HIV develop abscesses frequently and need to have treatment instituted urgently.

Additional procedures that may become necessary
  • Multiple incision and drainages for recurrent abscesses.
  • Debridement of necrotic tissue.
  • Packing abscess cavity and changing packs under anaesthesia for large abscess cavities.
Benefits
  • Resolution of sepsis.
  • Drainage of pus for microbiological culture and sensitivities.
Alternative procedures/conservative measures
  • Needle aspiration (breast/facial abscesses)
    • Disadvantage: Recurrence rates higher and multiple drainage procedures may be required.
  • Ultrasound or computed tomography (CT)-guided drainage of abscess.
  • Laparoscopic washout
    • Disadvantage: General anaesthesia required and invasive procedure; and

Advantage: Debridement or washout can be performed with irrigation of pelvic or intra-abdominal abscess cavities.

Serious/frequently occurring risks
  • Bleeding from injury to underlying vessels, especially in the neck, axilla, and groin.
  • Unsightly scar in event of large abscess requiring debridement of skin.
  • Prolonged period of wound healing, especially if there is underlying osteomyelitis.
  • Recurrence of abscess.
  • Fistula formation in the perianal region (incidence 15-25%).
  • Development of chronic sinus in presence of infected underlying foreign body, e.g. infected mesh, bony prosthesis, or vascular prosthetic graft.
Blood transfusion necessary
  • Group and save: The process of determining the patient’s ABO blood group and screening serum for the presence of antibodies to common red cell antigens that can cause transfusion reactions.
Type of anaesthesia/sedation
  • General.
  • Regional (spinal/epidural).
  • Local anaesthesia.
Follow-up or need for further procedure
  • Review as outpatient in clinic.
  • Often dressing change and packing by a nurse is required until the abscess cavity has healed to completion.

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