The common locations for abscesses to occur are?
In areas prone to friction or minor trauma, such as underneath a belt, the anterior thighs, buttocks, groin, axillae, waist and the proximal phalanges of the fingers
It commonly takes ____ to _____ days for an abscess to become fully “ripe”, complete with central core of necrosis.
4-6
T/F? An abscess is not a hollow sphere, but a cavity formed by fingerlike loculations of granulation tissue and pus that extends outward along planes of least resistance.
True
In individuals with recurring abscesses the infecting strain of bacteria may be found during quiescent periods in the _________, _____________, _____________ and/or the ___________.
nares, axillae, perineum and/or the navel (known as “incubator sites”)
T/F? generally, the microbiology of abscesses reflects the microflora of the anatomic part of the body involved
True
Approximately ____% of abscesses become sterile – some without antimicrobial treatment
Approximately 5% of abscesses become sterile – some without antimicrobial treatment
T/F?
Furunculosis occurs as either a self-limited infection in which one or several lesions are present OR as a chronic, recurrent disease that lasts for months or years, affecting one or several family members.
True
Predisposing factors for abscesses and furuncles?
- Traumatic inoculation of bacteria into the skin by a puncture wound, laceration, or surgical incision.
- Skin exposure to irritants and deodorants
- Poor hygiene; easily the most significant predisposing factor.
- Local causes of pruritis, such as insect bites and pediculosis capitis.
- Excessive sweating of the hands, feet and intertriginous site
- Climatic factors, primarily hot humid areas.
- Follicular abnormalities (comedones and acneiform papules and pustules) on the buttocks and axillae (suggests the diagnosis of hidradenitis suppurativa).
- Immunodeficiency
- Perhaps also diabetes mellitus
- Atopic dermatitis, eczema, and scabies.
The preferred sites for the development of carbuncles are ________________________________, ______________________________________ and ______________________________________
Areas with thick dermis, e.g., the back of the neck, the back of the trunk, and the lateral aspects of the thighs
Principal therapy of an abscess is still _____________and _______________.
Incision and drainage (I & D)
T/F?
If a drain has been placed in the opening after incision of an abscess it should be “advanced” gradually out of the opening and trimmed off each day as well (“advancing the drain”)
True
T/F?
Untreated abscesses often spontaneously rupture and drain or if early and small may shrink and resolve completely without incision and drainage
True
Pilonidal cysts typically present with a draining sinus in the midline and usually a secondary opening, almost always ________ cm. cephalad and to one side
2.5-5 cm
Be familiar with conservative treatment for pilonidal cysts
- Loose weight if needed.
- Keep the area clean – daily, gentle washing with washcloth
- Carefully remove any protruding hair on a regular basis.
- Avoid tight clothing
- Hot water baths/compresses, tea bag compresses or alternating hot and cold may -> spontaneous drainage!
- Potato, carrot, etc. poultices
- Zinc, multivitamin supplements
- Hepar sulphuris homeopathic
- Oral antimicrobials or antibiotics added to the home remedies may still not be enough to heala pilonidal cyst short of surgery!
___________________ is the preferred surgical technique for a new pilonidal cyst.
Incision and drainage
Understand the concept of marsupialization treatment of a pilonidal cyst
Incision and draining, removal of pus and hair, and sewing of the edges of the fibrous tract to the wound edges to make a pouch.
When to curve the ellipse?
In cutaneous surgery, it is often necessary to curve the line of closure to match or to parallel relaxed skin tension lines (i.e. around the eye or mouth).
