Incision and Drainage

1. Indications
   1. Furuncle (Skin Abscess)
2. Contraindications
   1. Furuncle of central face (risk of septic phlebitis)
      1. Infection below bridge of nose and above lip
      2. Treat with antibiotics and warm compresses
3. Precautions
   1. Avoid incision deeper than floor of lesion
   2. Follow closely and wound culture higher risk patients
      1. Diabetes Mellitus
      2. Immunocompromised patient
      3. Serious underlying comorbid conditions
   3. Wear protective eyewear during Incision and Drainage
4. Technique
   1. Clean overlying skin with betadine or hibiclens
   2. Inject Local Anesthesia in skin overlying Furuncle
      1. Avoid infiltrating abscess (poor efficacy)
   3. Incise lesion with number 11 blade
      1. Make adequately wide incision to prevent reclosure
   4. Culture from within abscess if indicated
   5. Break up loculations with hemostat
   6. Pack wound with sterile gauze packing
   7. Apply sterile dressing over incision
5. Post-procedure instruction
   1. Change wound packing daily
   2. Treat associated Cellulitis if present
      1. Antibiotics usually not needed if no Cellulitis
6. References
   1. Derksen in Pfenninger (1994) Procedures, p. 50-3
   2. Stulberg (2002) Am Fam Physician 66(1):119-24