Incision and drainage (I&D), also known as clinical lancing, are minor
surgical procedures 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,
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 ...
, or infected paranasal sinus. It is performed by treating the area with an
antiseptic
An antiseptic (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") is an antimicrobial substance or compound that is applied to living tissue/skin to reduce the possibility of infection, sepsis, or putre ...
, such as
iodine-based solution, and then making a small incision to puncture the skin using a
sterile instrument such as a sharp needle or a pointed
scalpel
A scalpel, lancet, or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various arts and crafts (either called a hobby knife or an X-acto knife.). Scalpels may be single-use dispos ...
. 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
A peripherally inserted central catheter (PICC or PIC line), less commonly called a percutaneous indwelling central catheter, is a form of intravenous access that can be used for a prolonged period of time (e.g., for long chemotherapy regimens ...
to enable readiness of treatment for possible
septic shock.
Adjunct antibiotics
Uncomplicated cutaneous abscesses do not need antibiotics after successful drainage.
In incisional abscesses
For
incisional abscesses, it is recommended that incision and drainage is followed by covering the area with a thin layer of
gauze 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
Methicillin-resistant ''Staphylococcus aureus'' (MRSA) is a group of Gram-positive bacteria that are genetically distinct from other strains of ''Staphylococcus aureus''. MRSA is responsible for several difficult-to-treat infections in humans. ...
.
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 siz ...
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 ...
* ''
''
References
{{Surgery
Surgical procedures and techniques