I&D

Question 1

Define Folliculitis

Answer 1

Superficial infection of the hair follicles in the epidermis

Question 2

Treatment of Folliculitis

Answer 2

Usually resolve spontaneously
Warm compresses
Avoid shaving involved areas

Question 3

Common Bug with Hot Tub Folliculitis

Answer 3

Pseudomonas aeroginosa

Question 4

Define Skin Abscess

Answer 4

Collection of pus within dermis & deeper skin tissues

Question 5

Define Furuncle (Boil)

Answer 5

Infection of hair follicle: pus extends through dermis into subQ tissue

Question 6

Define Carbuncle

Answer 6

Coalescence of several infected follicles into a single mass with several draining sites

Question 7

Contraindications or Concerns with an I&D

Answer 7

Abscess location may mandate drainage by surgeon
Abscess types
Patient factors
Will leave a scar & may return

Question 8

Abscess Locations that Should be Drained by a Surgeon

Answer 8

Perirectal area
Anterior & lateral neck
Breast near areola
Near vital nerves/blood vessels
Hand abscesses
Central triangle of face

Question 9

Abscess Types Indicating Surgical I&D

Answer 9

Recurrent & interconnected abscesses

>5 cm

Question 10

Patient Factors to Indicate Surgical I&D

Answer 10

Airway issues

Bleeding disorder or anticoagulation

Question 11

Risk Factors for Skin Abscesses

Answer 11

DM
Immunologic abnormalities
Breaches of skin barrier

Question 12

Pre-procedure Preparation

Answer 12

Evaluation of abscess
Medical issues
Patient counseling

Question 13

Medical Issues & I&D’s

Answer 13

Lidocaine allergy

Heart valve or total joint: need antibiotics

Question 14

Patient Counseling for I&D

Answer 14

Explain procedure, risk of recurrence, & scar formation
May need bigger incision than anticipated
Involves some discomfort
Explain after care
Will not be totally comfortable in out-patient setting

Question 15

When to Consider Antibiotic Therapy

Answer 15

Abscess >5 cm
Extensive cellulitis
Signs of systemic infection
Co-morbidities
Immunosuppression
Prosthetic joints & valves

Question 16

Antibiotic Agents for I&D’s

Answer 16

Clindamycin
Doxycycline
SMX/TMP
Vancomycin (MRSA, IV)

Question 17

Supplemental Sedation for Children or Large Abscesses

Answer 17

Lorazepam
IV MS or dilaudid
Have Narcan (naloxone) & Romazicon (flumazenil) on hand

Question 18

Equipment for I&D

Answer 18

Sterile gloves, drapes, & 4x4 gauze
Goggles or eye protection
Povidone-iodine solution
Local anesthetic
3-10 mL syringe with 25 or 27 gauge needle
Culture swab
#11 blade & scalpel handle
Curved hemostat, forceps, scissors
30-60 mL syringe with irrigation device with splash protection
Basin with sterile saline
Packing material
Dressing of choice

Question 19

I&D Procedure

Answer 19

Prep & drape wound
Establish anesthesia
Incise skin in line with natural folds
Culture pus within the wound
Spread wound with hemostat & look for pockets
Debride necrotic tissue
Irrigate with isotonic saline until wound is clear
Pack or drain wounds with significant dead space
Apply dressing
Antibiotics??

Question 20

Abscess Best Left Open in Which Patients

Answer 20

Immunocompromised
Systemic infections
Significant cellulitis

Question 21

When to Pack a Wound

Answer 21

Where there is a cavity
Keep wound from closing
Penrose drain

Question 22

Covering an Abscess

Answer 22

Sterile ace dressing

Sterile tape

Question 23

Instructions & Follow Up After an I&D

Answer 23

Leave dressing alone
Elevate extremity
Seek medical attention if: fever/chills, reaccumulation of pus, red streaks, increased swelling
Recheck wound in 24-48 hours

Question 24

Resolving Wounds After I&D Procedure

Answer 24

Soak in warm, soapy water or shower

Protect with dry, sterile dressing until wound is closed

Question 25

Complications More Likely In

Answer 25

Anterior facial triangle
Nose & mouth
Pilonidal cyst
Perirectal area

Question 26

Types of Complications with I&D Procedure

Answer 26

Inadequate drainage may result in local extension
Overly aggressive debridement may damage deep structures
Bacteremia