steps to performing incision and drainage of an abscess
- anesthetize the skin using more lidocaine than usual
- open lesion with #11 scalpal
- let contents drain from opening
- gently express contents of abscess
- if needed, break up pockets using hemostat
- pack cavity with iodine impregnated gauze or penrose drain.
- dress wound after applying calendula or minor surgery tincture
- have patient change dressing daily and return in 3 days for doctor to change drain
- repack wound at that time with less packing
- repeat daily dressing changes at home
* wear eye protection
why use a linear incision?
less scarring
why use a cruciate incision?
helps prevent premature wound closure during drainage/healing
what does it mean to advance the drain?
pull the gauze out an inch or so each day, trim off end, and then re-bandage.
- this allows for approximation of tissue at bottom of wound. Slowly heals as you take gauze out a little at a time.
ellipses should be ___ configuration ratio of length to width with ___ degree angles at the ends?
3:1 length to width ratio
30 degree angles at ends
why is the goal to cut skin edges perpendicular to the surface when doing elliptical excisions?
to allow for better eversion on closure
what are the options for treatment when a wound dehisces?
- watch for infection
- debride/clean/bandage prn
- monitor tension on remaining sutures
- let heal by “granulating in” (second intention)
what are the two options as methods of anesthesia for removing part/all of a finger/toenail?
- digital block with 1% lidocaine with 27 gauge needle.
- digital block with .25% bupivacaine or mix 1:1 (this is good for painful crush injuries or a prolonged procedure)
??? I think these are the two methods he’s asking about
name two reasons for/advantages of using a running lock stitch
- good for gathering loose skin
- used when you want a watertight seal
what are the possible pitfalls of attempting to drain an abscess before it has formed
bleeding without obtaining drainage
potential spreading of the infection
what is cryotherapy (bulk liquid nitrogen) used for?
- for freezing/removing benign lesions (subhorreic or actinic keratosis, warts)
- good for low volume users
- no anesthesia necessary
- no need to dress
- takes multiple sessions
