finger pads (felons), face, and deeper perirectal region can

be associated with complications. Consider consultation

with the appropriate surgical subspecialty.

EQUIPMENT

Povidone-iodine solution or chlorhexidine solution to

cleanse the skin

Anesthetic of 1 o/o lidocaine or 0.25% bupivacaine with

epinephrine

1 8-gauge needle (to aspirate anesthetic)

27-gauge needle and syringe (to inject local anesthesia)

Splash guard or 1 8-gauge angiocatheter (without needle)

30-mL syringe for irrigation

Sterile water or normal saline

1 1-blade scalpel

Swab for bacterial culture

Curved hemostat

;4-inch iodoform packing

Scissors

Gloves, gown, and facemask with shield (universal

precautions)

Gauze and tape

PROCEDURE

Discuss the risks and benefits of the procedure with the

patient before obtaining consent. Verify abscess location

with ultrasound if necessary. Wash your hands and wear

gloves, gown, and a face shield, as many abscesses are under

pressure. Position the patient and lighting to allow for the

best visualization and access to the abscess. Prepare the

area with povidone-iodine solution or chlorhexidine.

Utilizing a 27-gauge needle, inject the anesthetic j ust

under the dermis parallel to the surface of the skin.

Blanching of the tissue will occur as the anesthetic spreads

out through the skin. Cover the entire area to be incised.

Avoid injecting lidocaine into the abscess cavity. This may

increase the pressure in the cavity causing more pain. For

larger abscesses, local field blocks, parenteral analgesics,

and/or procedural sedation may be necessary.

If it is unclear whether an abscess exists, attempt aspiration of pus with a syringe and an 18- or 20-gauge needle.

If confirmed, use an 1 1-blade scalpel to make a single incision in the skin. The incision should be at the point of

maximal fluctuance oriented in the long axis of the abscess.

In general, the incision should extend two thirds of the

diameter of the abscess cavity ( except when draining

Bartholin gland abscesses, for which only an incision

0.5-1 em should be made). Attempt to incise parallel to

existing skin tension lines to promote cosmetic results.

Use gentle and steady pressure around the abscess to

express pus from the cavity. Insert a curved hemostat to

break loculations by working in a clockwise fashion

around the entire abscess cavity. This will also help identify

any deeper tracks. If desired, obtain a culture of the wound

at this time.