1. Incision and Drainage Bucky Boaz, ARNP-C

2. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

3. Pathogenesis INTACT SKIN HIGH CONCEN. OCCLUDE MOIST ENV. NUTRIENTS TRAUMA HOSTS MANUAL LABOR WOMEN IV DRUG USERS CELLULITIS NECROSIS LIQUIFY & ACCUM ABSCESS LOCULATION OF PUS

4. 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

5. Special Considerations Parental drug users Insulin-dependent diabetics Hemodialysis patients Cancer patients Transplant recipients

6. Laboratory Findings Offer no specific guidelines for therapy Not indicated Gram stain not indicated Routine culture not indicated –Except immunosuppressed

7. Indications and Contraindications Incision and drainage is definitive treatment Antibiotics alone are ineffective Premature incision Heat Nonsurgical recheck <24-36 hours

8. Ancillary Antibiotic Therapy Prophylactic Antibiotics –Endocarditis –Bacteremia in other conditions Therapeutic Antibiotics

9. Incision and Drainage Procedure Procedure site Equipment and Anesthesia Incision Wound Dissection Wound Irrigation Packing and Dressing

10. 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

11. Specific Abscess Therapy Staphyloccal Disease Hidradenitis Suppurativa Breast Abscess Bartholin Gland Abscess Pilonidal Abscess Infected Sebaceous Cyst

12. Specific Abscess Therapy Perirectal Abscess –Pathophysiology –Epidemiology –Physical and laboratory findings –treatment

13. Questions?