From the Guidelines
The incision depth for draining a skin abscess should be sufficient to allow complete drainage, with the goal of removing the collection of pus that serves as a bacterial reservoir and relieving pressure. When incising and draining a skin abscess, it is essential to make a linear incision with a #11 blade along the skin tension lines through the center of the abscess, ensuring it's large enough to allow complete drainage 1. The incision should be deep enough to penetrate the abscess cavity, but not so deep as to cause unnecessary damage to surrounding tissue. The primary treatment of skin abscesses remains surgical drainage, with the timing being dictated by the severity and nature of any sepsis. In general, the incision should be kept as close as possible to the anal verge to minimize the length of a potential fistula, while still providing adequate drainage and avoiding sphincteral damage 1. Some key points to consider when incising and draining a skin abscess include:
- Obtaining informed consent and gathering sterile supplies
- Cleaning the area with chlorhexidine or povidone-iodine solution and administering local anesthesia
- Making a linear incision with a #11 blade along the skin tension lines through the center of the abscess
- Expressing all purulent material and obtaining a culture specimen
- Breaking up any loculations using a hemostat or finger to ensure complete drainage
- Irrigating the cavity with sterile saline solution
- Applying a sterile dressing and instructing the patient to change the dressing daily
- Considering the use of packing for deeper or complex abscesses to prevent premature closure
- Evaluating the patient in 24-48 hours for possible packing removal or replacement. Antibiotics are not routinely needed for simple abscesses after drainage unless the patient has systemic symptoms, extensive cellulitis, immunocompromise, or abscesses in sensitive areas 1. This procedure is effective because it removes the collection of pus that serves as a bacterial reservoir and relieves pressure, allowing the body's natural healing processes to resolve the infection.
From the Research
Incision Depth in Skin Abscess
The proper procedure for incising and draining a skin abscess involves making an incision to allow for the drainage of purulent material.
- The incision should be large enough to allow for adequate drainage, but not so large that it causes unnecessary damage to the surrounding tissue.
- There is no specific guideline for the incision depth, as it may vary depending on the size and location of the abscess.
Procedure for Incising and Draining
The procedure for incising and draining a skin abscess typically involves the following steps:
- The area around the abscess is cleaned and disinfected to prevent infection.
- A local anesthetic may be used to numb the area, if necessary.
- An incision is made in the skin to allow for drainage of the abscess.
- The purulent material is drained and the area is irrigated with saline solution.
- The incision may be packed with gauze to help absorb any remaining drainage and promote healing.
Post-Procedure Care
After the procedure, the area should be kept clean and dry to promote healing.
- The dressing should be changed regularly to prevent infection.
- Antibiotics may be prescribed if there is a high risk of infection or if the abscess is large or deep, as noted in studies 2, 3, 4.
- Pain management may be necessary, as the area may be sore or tender after the procedure.
Evidence for Incision and Drainage
Studies have shown that incision and drainage is an effective treatment for skin abscesses, with high rates of clinical cure 5, 3, 6.