28. Peker E, Cagan E, Dogan M. et al. Methemoglobinemia due to

local anesthesia with prilocaine for circumcision.J Pediatr Child

Health. 2010;46(6):362.

29. Moran LR, Hossain T, Insoft RM. Neonatal seizures following

lidocaine administration for elective circumcision. J Perinatol.

2004;24:395.

30. Feinberg AN, Blazek MA. Mechanical complications of circumcision with a Gomco clamp. Am J Dis Child. 1988;142:813.

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An N. Massaro

Khodayar Rais-Bahrami

48 Drainage of Superficial Abscesses

A. Definitions

A Superficial abscess is

1. A localized collection of pus resulting from bacterial

organisms that cause necrosis, liquefaction, accumulation of leukocytes and debris, which presents as a fluctuant soft tissue swelling that may have associated erythema and induration (Fig. 48.1) (1–5)

2. In newborns, usually caused by invasion of local bacterial flora (2), direct inoculation, (e.g., animal bites) (6)

or skin piercing (7)

B. Indications

1. To establish free drainage of contents from a superficial

abscess

Surgical incision and drainage is the definitive

treatment for soft tissue abscesses. Antibiotic therapy

alone is ineffective in the setting of localized abscess

(1,2,8–11)

2. To identify pathogens and direct antimicrobial therapy

if needed (2,12–16)

3. To differentiate infectious from noninfectious lesions

(15,17,18)

C. Contraindications

1. Carefully identify and avoid

a. Cephalohematoma

b. Hemangioma

c. Cystic hygroma

d. Encephalocele

2. Avoid premature incision and drainage of abscesses that

have not yet fully matured (i.e., in the initial stages of

induration and inflammation prior to formation of pus)

(4). This may lead to

a. A noncurative intervention

b. Possible extension of infectious process

c. Bacteremia

Premature incision may be avoided by the use of

ultrasound with or without diagnostic needle aspiration (19,20).

D. Equipment

Sterile

1. Gloves and gown

2. Antiseptic swabs or cup containing antiseptic solution

3. 1-mL syringe

4. Nonbacteriostatic, isotonic saline without preservative

5. 23-gauge needle

6. 2- × 2-inch gauze squares

7. Scalpel with no. 11 blade

8. Cotton-tipped culture swab

9. Mosquito hemostat

10. 0.5-inch, fine-mesh, plain gauze

Nonsterile

1. Ethyl chloride spray as topical anesthetic. (For larger

lesions, local anesthesia with lidocaine may be used.)

2. Mask and cap

3. Adhesive tape

E. Precautions

1. Use appropriate isolation techniques to safeguard other

infants.