Incision and Drainage, Biopsy

Question 1

Describe an abscess?

What is the most common etiology?

Answer 1

• Localized infection of tissue
• Marked by collection of purulent fluid surrounded by inflamed tissue
• Walled off cavity/envelope

Staphylococcus

Question 2

What are the most common causative agents for an abscess?

Answer 2

• Streptococcus
• Staphylococcus
• Enteric bacteria (perianal)

Question 3

Abscesses in these locations typically require urgent attention?

Where can abscesses occur?

Answer 3

• Extremities
• Buttocks
• Breast
• Perianal Area
• Hair Follicle

Anywhere

Question 4

Routine culture for an abscess is not indicated with the exception of what patient population?

Answer 4

Immunosuppressed

Question 5

What is the definitive treatment of an abscess?

Answer 5

Incision and Drainage

Question 6

What defines a small abscess?

What is the treatment?

Answer 6

< 5mm diameter

May respond to conservative measures and doesn’t need I&D

Conservative measures include warm soaks, saltwater soaks to promote drainage

Question 7

Extremely large abscesses may require treatment in what setting?

Answer 7

Best treated in the OR, they maybe bigger than meets the eye

Question 8

What types of abscesses are I&D contraindicated?

Answer 8

• Deep abscesses - require surgery with anesthesia
• Palmar or plantar space
• Abscess in the nasolabial fold (may drain to sphenoid sinus, causing a spetic phlebitis)

Question 9

What level of precautions are followed for I&D?

Answer 9

Universal Precautions

Eyewear and Gloves

Question 10

What are the types of anesthetics used in I&D?

Answer 10

• 1% or 2% lidocaine (+/- epi)
• Sensorcaine
• Marcaine

Question 11

Where can you not inject epinephrine?

Why?

Answer 11

• Fingers
• Toes
• Ears
• Penis
• Nose

Will cause vasoconstriction of small vessles leading to ischemia

Question 12

What are the two options for holding the scalpel during an I&D?

What is the most commonly used sized blade?

Answer 12

• Pencil Hold: thumb and third finger holding knife, with index finger controlling dissection
• 3-Point Hold: have 3 points of contact between hand, instrument to increase precision

#10 blade; linear incisions in skin or other connective tissue

Question 13

What size blade is usually used for stab incisions or delicate procedures?

What blade is used for fine precision work?

Answer 13

11 blade

#15 blade

Question 14

How much anesthetic is used in an I&D?

Answer 14

5-10cc

Question 15

Is scarring possible in an I&D Procedure?

Answer 15

Yes, patient should be informed prior to procedure

Question 16

What type of biopsy is used for raised lesions?

Answer 16

Superficial shave biopsy

Question 17

Which biopsy yields full-thickness samples and can be use for lesions that require dermal or subcutaneous tissue for diagnosis

Answer 17

Punch biopsy

Question 18

What biopsy will allow for removal of the entire lesion for diagnostic purposes?

Answer 18

Incisional biopsies

Question 19

What patient instructions should be given after a biopsy?

Answer 19

• Keep wound clean, dry, and covered with absorbent material
• If abscess contains packing gauze, it should be removed and repacked every 1 to 2 days
• Dressing should be changed daily
• Can take pain relievers
• Instructions and warning signs of infection