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Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Treatment for early-onset infection consists of antibiotic therapy such as penicillin 4 million units intravenously every 4 hours or cefazolin 2 g intravenously every 6 hours, and prompt debridement of necrotic tissue (71). Later infections usually respond to simple incision and drainage. Antibiotics are required only if there is extensive cellulitis, bacteremia, or failure to defervesce within 12 to 24 hours of opening the wound (71). Debridement under anesthesia is sometimes required (70). Fascial dehiscence of the wound occurs in 0.5% of post-cesarean patients and may be more common when wound infection is present (64,70). Fascial repair under anesthesia may be necessary. Modern management of open wounds, including secondary closure within 1 to 4 days of disruption, negative pressure wound therapy (vacuum-assisted closure), or healing by secondary intention with dressings that keep the wound moist and absorb drainage, has been shown to be superior to frequently changed, traditional “wet-to-dry” dressings and cleansers that disrupt wound healing (65).
Vulvar and Vaginal Trauma and Bartholin Gland Disorders
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Malak El Sabeh, Mostafa A. Borahay
Small cysts usually resolve on their own. In the case of large, symptomatic cysts or abscess formation, treatment is incision and drainage. Incision and drainage alone can often lead to recurrence, so a Word catheter is placed for 4 to 6 weeks until epithelialization of the cyst and tract. Alternatively, marsupialization is usually done for recurrent Bartholin cysts or abscesses where the entire cyst or abscess is incised. Other reported treatments include silver nitrate gland ablation, use of carbon dioxide laser to create an opening in the skin, alcohol sclerotherapy, and needle aspiration [32]. Antibiotics are not usually indicated, but in the case of recurrent Bartholin cyst abscesses, antibiotics with polymicrobial coverage are considered. They should also be given if the cultured organism was N gonorrhoeae, which is the case approximately 10% of the time. If the patient is older than 40 years, a biopsy should be performed to rule out Bartholin gland carcinoma.
Perianal Abscess
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Anal abscesses require incision and drainage. After drainage, the area is left open. Because of the risk of deep infection, sepsis and necrotizing soft tissue infection, patients who are immunosuppressed, have diabetes or have evidence of systemic sepsis or cellulitis require urgent drainage on the day of presentation. Incision and drainage can be performed under general anaesthesia or local anaesthesia. In superficial abscesses or in pregnant women, local anaesthesia is preferred. General anaesthesia, on the other hand, allows for sigmoidoscopy and detailed assessment of the anorectum. Proctitis, strictures, ulcers, fissures, recurrent abscesses and fistulas and an elevated calprotectin support diagnosis of Crohn's disease. The addition of antibiotics to drainage does not improve healing rates or reduce recurrence. In individuals who are apyrexial and clinically well, antibiotics are not indicated. Fistulas require surgical excision.
Endoscopic and radiological evidence refuting intra-abscess septae
Published in Orbit, 2023
Nandini Bothra, Pragya Saini, Mohammad Javed Ali
Incision and drainage for lacrimal abscess has been a regular practice for decades. Penetration of the antibiotics in the abscess cavity is often poor and hence the response to systemic antibiotics has been sub-optimal.2,5,10 Incision and drainage controls the infection by draining the abscess, providing instant pain relief, and also providing material for microbiology exams for a tailor specific treatment.2–5,11 However, the process has several disadvantages, including pain, the need for local anaesthesia, secondary infections of the wound itself, and a possibility of forming a lacrimo-cutaneous fistula.2–4 Incision and drainage as a technique was also preferred as it was believed that multiple septae exist within the abscess cavity which need to be severed in order to achieve complete drainage.3 These loculations were believed to be present mainly in the submuscular pockets formed as a result of seepage of contents from the sac into the submuscular space.3
Red blood cell distribution width as a potential inflammatory marker in pediatric osteomyelitis
Published in Baylor University Medical Center Proceedings, 2023
Irem Eldem, Mhd Hasan Almekdash, Obada Almadani, Fatma Levent, Mohamad M. Al-Rahawan
Our study group was composed of 82 children with osteomyelitis. The characteristics of patients are shown in Table 1. The most common presenting signs were fever, inflammation of the affected joint, and limping. The blood culture was positive in 31 (37%) patients. The pathogens isolated in the blood culture were Staphylococcus aureus (81%), Streptococcus species (16%), and Propionibacterium acnes (3%). Seventy-five patients required incision and drainage (range 1–8 times). The drainage culture was positive in 49 patients. The isolated pathogens were dominantly methicillin-resistant S. aureus and methicillin-sensitive S. aureus. Other pathogens were Pseudomonas, Enterobacter, Eikenella, Hemophilus, and Enterococcus species. A total of 28 (34%) patients had a trauma history preceding the osteomyelitis diagnosis. Two patients, one with underlying psoriasis and the other with osteosarcoma, were diagnosed with prosthesis-related osteomyelitis. Only 12 patients (14.5%) had a comorbid disease, which included chronic multifocal osteomyelitis, spina bifida, cerebral palsy with spastic paraplegia, osteosarcoma, psoriasis, asthma, dermoid cyst of bone, and congenital heart disease. Two patients were discharged with crutches. Osteomyelitis recurred in 16 patients (19.5%). The median length of stay in the hospital was 8 days (range 1–45). The patients required antibiotics for a median of 70 days, 32 days parenteral and 39 days oral (interquartile range 7–42 and 14–42, respectively).
Transnasal drainage prevents surgical cavity related complications in transoral robotic surgery resected parapharyngeal space tumors
Published in Acta Oto-Laryngologica, 2023
Chunping Wu, Chengzhi Xu, Huiching Lau, Xiaoling Shi, Quan Liu, Liang Zhou, Lei Tao
Some scholars may choose to partially suture the surgical incision without drainage, and use the partially open surgical incision as ‘natural’ drainage. However, based on our experience, we believe that this approach is not the first choice. The reasons are as follows: firstly, although the effusion in the surgical cavity can be drained out from the reserved non sutured surgical incision. At the same time, saliva, bacteria and food can also enter the surgical cavity through this channel to cause infection because the drainage is bidirectional. Secondly, it is difficult to determine the length of the reserved surgical incision. If the reserved surgical incision is too short, it is easy to close and cause effusion in the surgical cavity. If it is too long, the risk of infection caused by food and bacteria entering the surgical cavity increases. Thirdly, from the perspective of clinical effect, it is difficult for patients with reserved non sutured surgical incision to achieve G1 healing of both HGSI and HGSC.