Technique of incision and drainage for skin abscess
- Kathleen A Downey, MD
Kathleen A Downey, MD
- Associate Clinical Professor of Family Medicine
- University of Cincinnati
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Approximately 2 percent of emergency department visits are for the evaluation of skin abscesses. Most lesions are caused by Staphylococcus aureus [1-3], and many of these patients undergo incision and drainage.
The differential diagnosis and procedure for incision and drainage of skin abscesses will be reviewed here. The epidemiology, microbiology, treatment, and prevention of skin abscess are discussed separately. (See "Cellulitis and skin abscess: Treatment".)
Skin abscesses can be differentiated from folliculitis, furuncles, and carbuncles as follows:
Folliculitis — Folliculitis is a superficial bacterial infection of the hair follicles with purulent material in the epidermis (picture 1).
Furuncle — A furuncle is a well-circumscribed, painful, suppurative inflammatory nodule involving hair follicles that usually arises from preexisting folliculitis. A furuncle can occur at any site that contains hair follicles, especially in regions that are subject to friction and maceration (eg, face, neck, axillae, groin, thighs, and buttocks). The lesion may extend into the dermis and subcutaneous tissues and often serves as a nidus for cellulitis and skin abscess.
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- Meislin HW, Lerner SA, Graves MH, et al. Cutaneous abscesses. Anaerobic and aerobic bacteriology and outpatient management. Ann Intern Med 1977; 87:145.
- Meislin HW, McGehee MD, Rosen P. Management and microbiology of cutaneous abscesses. JACEP 1978; 7:186.
- Sivitz AB, Lam SH, Ramirez-Schrempp D, et al. Effect of bedside ultrasound on management of pediatric soft-tissue infection. J Emerg Med 2010; 39:637.
- Halvorson GD, Halvorson JE, Iserson KV. Abscess incision and drainage in the emergency department--Part I. J Emerg Med 1985; 3:227.
- Halvorson GD, Halvorson JE, Iserson KV. Abscess incision and drainage in the emergency department (Part 2). J Emerg Med 1985; 3:295.
- Johnston M, Dickinson G. An unexpected surprise in a common boil. J Emerg Med 1996; 14:779.
- Brewer TF, Wilson ME, Gonzalez E, Felsenstein D. Bacon therapy and furuncular myiasis. JAMA 1993; 270:2087.
- Gewirtzman A, Rabinovitz H. Botfly infestation (myiasis) masquerading as furunculosis. Cutis 1999; 63:71.
- Gaspari RJ, Resop D, Mendoza M, et al. A randomized controlled trial of incision and drainage versus ultrasonographically guided needle aspiration for skin abscesses and the effect of methicillin-resistant Staphylococcus aureus. Ann Emerg Med 2011; 57:483.
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- Derkson, DJ. Incision and drainage of an abscess. In: Procedures for primary care physicians, 1st ed, Pfenninger, J, Fowler, GC (Eds), Mosby, St. Louis 1994. p.50.
- Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med 2005; 12:601.
- Blaivas M, Adhikari S. Unexpected findings on point-of-care superficial ultrasound imaging before incision and drainage. J Ultrasound Med 2011; 30:1425.
- Iverson K, Haritos D, Thomas R, Kannikeswaran N. The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED. Am J Emerg Med 2012; 30:1347.
- Berger T, Garrido F, Green J, et al. Bedside ultrasound performed by novices for the detection of abscess in ED patients with soft tissue infections. Am J Emerg Med 2012; 30:1569.
- Marin JR, Dean AJ, Bilker WB, et al. Emergency ultrasound-assisted examination of skin and soft tissue infections in the pediatric emergency department. Acad Emerg Med 2013; 20:545.
- Daly, L, Durani, Y. Incision and drainage of a cutaneous abscess. In: Textbook of Pediatric Emergency Procedures, 2nd ed, King, C, Henretig, FM (Eds), Lippincott, Williams and Wilkins, Philadelphia 2008. p.1079.
- Abrahamian FM, Shroff SD. Use of routine wound cultures to evaluate cutaneous abscesses for community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med 2007; 50:66.
- Korownyk C, Allan GM. Evidence-based approach to abscess management. Can Fam Physician 2007; 53:1680.
- Singer AJ, Thode HC Jr, Chale S, et al. Primary closure of cutaneous abscesses: a systematic review. Am J Emerg Med 2011; 29:361.
- Singer AJ, Taira BR, Chale S, et al. Primary versus secondary closure of cutaneous abscesses in the emergency department: a randomized controlled trial. Acad Emerg Med 2013; 20:27.
- Leinwand M, Downing M, Slater D, et al. Incision and drainage of subcutaneous abscesses without the use of packing. J Pediatr Surg 2013; 48:1962.
- O'Malley GF, Dominici P, Giraldo P, et al. Routine packing of simple cutaneous abscesses is painful and probably unnecessary. Acad Emerg Med 2009; 16:470.
- Kessler DO, Krantz A, Mojica M. Randomized trial comparing wound packing to no wound packing following incision and drainage of superficial skin abscesses in the pediatric emergency department. Pediatr Emerg Care 2012; 28:514.
- Alimov V, Lovecchio F, Sinha M, et al. Use of a silver-containing hydrofiber dressing for filling abscess cavity following incision and drainage in the emergency department: a randomized controlled trial. Adv Skin Wound Care 2013; 26:20.
- Mahasin Z, Saleem M, Quick CA. Multiple bilateral orbital abscesses secondary to nasal furunculosis. Int J Pediatr Otorhinolaryngol 2001; 58:167.
- Skin abscess
- DIFFERENTIAL DIAGNOSIS
- Evaluation for abscess
- Patient counseling
- Sedation and analgesia
- - Local anesthesia
- Probing and irrigation
- Packing or drain placement
- - Indications
- - Technique
- Antibiotic therapy
- Tetanus prophylaxis
- WOUND CARE AND INSTRUCTIONS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS