Incision and drainage (I&D), also known as clinical lancing, are minor
surgical procedure
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
s to release
pus
Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection ...
or pressure built up under the skin, such as from an
abscess
An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...
,
boil
A boil, also called a furuncle, is a deep folliculitis, which is an infection of the hair follicle. It is most commonly caused by infection by the bacterium ''Staphylococcus aureus'', resulting in a painful swollen area on the skin caused by an ...
, or infected paranasal sinus. It is performed by treating the area with an
antiseptic, such as
iodine
Iodine is a chemical element with the symbol I and atomic number 53. The heaviest of the stable halogens, it exists as a semi-lustrous, non-metallic solid at standard conditions that melts to form a deep violet liquid at , and boils to a vi ...
-based solution, and then making a small incision to puncture the skin using a
sterile
Sterile or sterility may refer to:
*Asepsis, a state of being free from biological contaminants
* Sterile (archaeology), a sediment deposit which contains no evidence of human activity
*Sterilization (microbiology), any process that eliminates or ...
instrument such as a sharp needle or a pointed
scalpel. This allows the pus fluid to escape by draining out through the incision.
Good medical practice for large abdominal abscesses requires insertion of a drainage tube, preceded by insertion of a
PICC line to enable readiness of treatment for possible
septic shock
Septic shock is a potentially fatal medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism. The Third International Con ...
.
Adjunct antibiotics
Uncomplicated cutaneous abscesses do not need antibiotics after successful drainage.
In incisional abscesses
For
incisional abscess
An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...
es, it is recommended that incision and drainage is followed by covering the area with a thin layer of
gauze
Gauze is a thin, translucent fabric with a loose open weave. In technical terms "gauze" is a weave structure in which the weft yarns are arranged in pairs and are crossed before and after each warp yarn keeping the weft firmly in place. ...
followed by sterile
dressing. The dressing should be changed and the wound irrigated with normal saline at least twice each day.
In addition, it is recommended to administer an antibiotic active against staphylococci and streptococci, preferably
vancomycin
Vancomycin is a glycopeptide antibiotic medication used to treat a number of bacterial infections. It is recommended intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, ...
when there is a risk of
MRSA.
The wound can be allowed to close by
secondary intention
Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue.
In undamaged skin, the epidermis (surface, epithelial layer) and dermis (deeper, connective layer) form a protective barrier agains ...
. Alternatively, if the infection is cleared and healthy
granulation tissue
Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size ...
is evident at the base of the wound, the edges of the incision may be reapproximated, such as by using
butterfly stitches
An adhesive bandage, also called a sticking plaster, medical plaster, or simply plaster in British English, is a small medical dressing used for injuries not serious enough to require a full-size bandage. They are also known by the genericized tra ...
,
staples or
sutures.
See also
*
Drain (surgery)
A surgical drain is a tube used to remove pus, blood or other fluids from a wound, body cavity, or organ. They are commonly placed by surgeons or interventional radiologists after procedures or some types of injuries, but they can also be used a ...
* ''
Ubi pus, ibi evacua''
References
{{Surgery
Surgical procedures and techniques