Week 7

Question 1

steps to performing incision and drainage of an abscess

Answer 1

1. anesthetize the skin using more lidocaine than usual
2. open lesion with #11 scalpal
3. let contents drain from opening
4. gently express contents of abscess
5. if needed, break up pockets using hemostat
6. pack cavity with iodine impregnated gauze or penrose drain.
7. dress wound after applying calendula or minor surgery tincture
8. have patient change dressing daily and return in 3 days for doctor to change drain
9. repack wound at that time with less packing
10. repeat daily dressing changes at home
    * wear eye protection

Question 2

why use a linear incision?

Answer 2

less scarring

Question 3

why use a cruciate incision?

Answer 3

helps prevent premature wound closure during drainage/healing

Question 4

what does it mean to advance the drain?

Answer 4

pull the gauze out an inch or so each day, trim off end, and then re-bandage.
- this allows for approximation of tissue at bottom of wound. Slowly heals as you take gauze out a little at a time.

Question 5

ellipses should be ___ configuration ratio of length to width with ___ degree angles at the ends?

Answer 5

3:1 length to width ratio

30 degree angles at ends

Question 6

why is the goal to cut skin edges perpendicular to the surface when doing elliptical excisions?

Answer 6

to allow for better eversion on closure

Question 7

what are the options for treatment when a wound dehisces?

Answer 7

• watch for infection
• debride/clean/bandage prn
• monitor tension on remaining sutures
• let heal by “granulating in” (second intention)

Question 8

what are the two options as methods of anesthesia for removing part/all of a finger/toenail?

Answer 8

• digital block with 1% lidocaine with 27 gauge needle.
• digital block with .25% bupivacaine or mix 1:1 (this is good for painful crush injuries or a prolonged procedure)
  ??? I think these are the two methods he’s asking about

Question 9

name two reasons for/advantages of using a running lock stitch

Answer 9

• good for gathering loose skin

- used when you want a watertight seal

Question 10

what are the possible pitfalls of attempting to drain an abscess before it has formed

Answer 10

bleeding without obtaining drainage

potential spreading of the infection

Question 11

what is cryotherapy (bulk liquid nitrogen) used for?

Answer 11

• for freezing/removing benign lesions (subhorreic or actinic keratosis, warts)
• good for low volume users
• no anesthesia necessary
• no need to dress
• takes multiple sessions