From the Research
For an abscess on the chest near the sternum, the recommended incision is typically horizontal, following Langer's lines. Make a horizontal incision parallel to the ribs, about 1-2 cm in length depending on the size of the abscess. This approach minimizes scarring and promotes better healing. Before incision:
- Clean the area with chlorhexidine or povidone-iodine
- Use local anesthesia (e.g., 1% lidocaine with epinephrine)
- Ensure proper sterile technique After incision:
- Express pus and debris
- Irrigate the cavity with sterile saline
- Consider packing with iodoform gauze if the cavity is large
- Apply a sterile dressing Following Langer's lines (natural skin tension lines) results in less tension on the wound edges, which can lead to a less noticeable scar and reduced risk of wound dehiscence. In the chest area, these lines generally run horizontally, parallel to the ribs. Remember to obtain cultures before starting empiric antibiotics, which may be necessary depending on the severity and location of the infection. Follow up in 24-48 hours to reassess and potentially remove packing if used.
The optimal incision orientation is supported by the general principles of surgical incisions, which prioritize minimizing scarring and promoting healing 1, 2, 3, 4, 5. Although the provided studies do not directly address the optimal incision orientation for an abscess on the chest near the sternum, the principle of following Langer's lines is a well-established concept in surgery.
In terms of specific treatment approaches, a study on loop drainage and primary incision & drainage techniques in adult patients with cutaneous abscess found that both methods were similar in terms of abscess resolution and complications 5. Another study on the use of a high-vacuum wound drainage system found that it reduced pain and length of treatment for pediatric soft tissue abscesses 4. However, these studies do not provide direct evidence for the optimal incision orientation.
A more recent study on primary sternal osteomyelitis highlights the importance of early antimicrobial treatment and surgical debridement in the treatment of deep-seated infections 3. While this study does not address the optimal incision orientation, it emphasizes the need for prompt and effective treatment of severe infections.
Overall, the recommended approach is based on general surgical principles and the available evidence on the treatment of soft tissue abscesses. The horizontal incision orientation, following Langer's lines, is the most appropriate approach for an abscess on the chest near the sternum.