From the Guidelines
A left perichondrial abscess requires prompt medical attention with a combination of antibiotics and surgical drainage to prevent cartilage destruction and permanent ear deformity. The treatment should include initial empiric antibiotic therapy with coverage for Pseudomonas aeruginosa and Staphylococcus aureus, such as ciprofloxacin 500mg orally twice daily plus clindamycin 300mg orally four times daily for adults, as suggested by 1. Surgical intervention is essential and involves incision and drainage of the abscess with removal of any necrotic cartilage, typically performed under local anesthesia with careful incision along the natural curves of the ear to minimize cosmetic impact, as noted in 1. Following drainage, the wound should be irrigated with saline and may require placement of a small drain. Patients should continue antibiotics for 10-14 days total and follow up within 24-48 hours after drainage. Warm compresses can help with pain and swelling. Without proper treatment, the infection can lead to cartilage destruction and permanent ear deformity known as "cauliflower ear," as warned by 1. The perichondrium provides blood supply to the avascular cartilage, so infections in this space are particularly dangerous as they can separate the perichondrium from the cartilage, compromising its blood supply. Some key points to consider in the treatment of left perichondrial abscess include:
- Prompt medical attention is crucial to prevent complications
- Antibiotic therapy should include coverage for Pseudomonas aeruginosa and Staphylococcus aureus
- Surgical drainage is essential to remove the abscess and any necrotic cartilage
- Careful incision and drainage techniques are necessary to minimize cosmetic impact
- Patients should be closely monitored for signs of complications, such as cartilage destruction or systemic illness, as advised by 1 and 1.
From the Research
Definition and Diagnosis of Abscess
- An abscess is a localized collection of purulent material surrounded by inflammation and granulation in response to an infectious source 2.
- Abscesses can be diagnosed upon clinical examination and managed with incision and drainage 2.
- Ultrasonography can be valuable in diagnosing abscesses that are not clinically evident and in guiding incision and drainage procedures 3.
Management of Abscesses
- Incision and drainage is a common method for managing abscesses, and wound culture and antibiotics may not improve healing 2.
- Packing wounds larger than 5 cm may reduce recurrence and complications 2.
- Antibiotics, needle aspiration, and loop drainage are suitable alternatives to incision and drainage of abscesses with certain characteristics 3.
- Oral antibiotics can improve outcomes after incision and drainage, although this improvement must be weighed against potential risks 3.
Specific Types of Abscesses
- Perichondritis is an infection of the tissue surrounding the cartilage, and it must be recognized and treated promptly to avoid necrosis of the underlying avascular cartilage and auricular deformity 4.
- There is no specific information available on left perichondrial abscesses in the provided studies, but the management of abscesses in general can be applied to this type of abscess.
- The use of topical vancomycin has been shown to be safe and effective in reducing the risk of surgical site infections in neurosurgical patients 5.
- The antibiotic susceptibilities of Propionibacterium acnes isolates from central nervous system infections have been evaluated, and vancomycin, cefotaxime, and ciprofloxacin have been shown to be effective against this bacterium 6.