Incision and Drainage

Butler, Kenneth H.

doi:10.1016/b978-1-4160-3623-4.00037-7

Cited by 11 publications

(18 citation statements)

References 124 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study demonstrated that most providers treat pain associated with I&D with local lidocaine and often with additional oral or intravenous narcotics. Although most references recommend at least local anesthesia, there is some discrepancy regarding the need for additional systemic pain management 4–10. The difference in abscess size, location, and patient’s pain threshold may account for this variability in practice.…”

Section: Discussionmentioning

confidence: 99%

“…Irrigation, though recommended by most textbooks and cited guidelines,4–10 is routinely done by only about half of respondents. There is little consensus on the type and volume of fluid that should be used to irrigate the cavity.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple consensus documents and textbooks offer procedure guidelines for management of simple cutaneous abscesses, yet there is little evidence to support these practices (Table 1). 4–10 The only consensus on treatment is incision and drainage (I&D), but specific recommendations regarding incision type, irrigation, packing, pain management, wound cultures, and timing for follow-up visits vary widely. One study demonstrated variation by provider type and experience, suggesting practice patterns for I&D technique are not standardized, even within a single institution 11.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers' Practice Patterns

Schmitz¹,

Goodwin²,

Singer³

et al. 2013

WestJEM

View full text Add to dashboard Cite

IntroductionCutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting.Methods:Four hundred and seventy-four surveys were distributed to 15 EDs across the United States. Participants were queried about their level of training and practice environment as well as specific questions regarding their management of cutaneous abscesses in the ED.Results:In total, 350 providers responded to the survey (74%). One hundred eighty-nine respondents (54%) were attending physicians, 135 (39%) were residents, and 26 (7%) were midlevel providers. Most providers (76%) used narcotics for pain management, 71% used local anesthetic over the roof of the abscess, and 60% used local anesthetic in a field block for pain control. More than 48% of responders routinely used irrigation after (I&D). Eighty-five percent of responders used a linear incision to drain the abscess and 91% used packing in the wound cavity. Thirty-two percent routinely sent wound cultures and 17% of providers routinely prescribed antibiotics. Most providers (73%) only prescribed antibiotics if certain historical factors or physical findings were present on examination. Antibiotic treatment, if used, favored a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcus aureus (47%). Follow-up visits were most frequently recommended at 48 hours unless wound was concerning and required closer evaluation.Conclusion:Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present. Limited evidence is available at this time to guide these treatment strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers' Practice Patterns

Schmitz¹,

Goodwin²,

Singer³

et al. 2013

WestJEM

View full text Add to dashboard Cite

show abstract

“…Removal of the packing material has also been suggested as a way to provide gentle debridement of necrotic tissue from within the cavity site. [1][2][3][4] None of the theories regarding packing of cutaneous abscesses have been demonstrated in any scientific way, and it is the experience of the primary author that physicians in developing countries do not routinely pack abscesses because they have not the supplies or capacity to do so.…”

Section: Discussionmentioning

confidence: 99%

“…Emergency medicine and surgical references cite incision, drainage, and packing as important aspects of abscess management, but evidence for the recommendations is unclear. [1][2][3][4] Traditional teaching is that packing an abscess is necessary for several theoretical reasons (to prevent incomplete collapse of the cavity with infected material trapped inside it or to assist in development of an epithelial lining in the cavity), but none of these theories are well supported by science. There is no evidence that packing a cutaneous abscess after I&D influences or improves outcome.…”

mentioning

confidence: 99%

Routine Packing of Simple Cutaneous Abscesses Is Painful and Probably Unnecessary

O’Malley

Dominici

Giraldo

et al. 2009

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: The objective was to determine whether the routine packing of simple cutaneous abscesses after incision and drainage (I&D) confers any benefit over I&D alone.Methods: In a prospective, randomized, single-blinded trial, subjects with simple cutaneous abscesses (less than 5 cm largest diameter) underwent incision, drainage, irrigation, and standard abscess preparation in the usual manner. Subjects were then randomized to either packing or no-packing. Visual analog scales (VAS; 100 mm) of pain were recorded in the emergency department (ED). All patients received trimethoprim-sulfamethoxazole (TMP-SMX), ibuprofen, and narcotic prescriptions, recorded twice daily VAS pain scores, and returned in 48 hours at which time dressings and packing, if present, were removed and a physician blinded to the randomization and not part of the initial visit repeated measurements and determined the need for further intervention.Results: Forty-eight subjects were included in the final analysis. There were no significant differences in age, sex, abscess location, or initial pain scores between the two groups. There was no significant difference in need for a second intervention at the 48-hour follow-up between the packed (4 of 23 subjects) and nonpacked (5 of 25 subjects) Conclusion:In this pilot study, not packing simple cutaneous abscesses did not result in any increased morbidity, and patients reported less pain and used fewer pain medications than packed patients.

show abstract