Introduction to the clinical stations
Sukhpreet Singh Dubb in Core Surgical Training Interviews, 2020
In asymptomatic patients, local hair removal through shaving or laser therapy is encouraged alongside hygiene of the affected area. Symptomatic patients with no abscess formation should undergo surgical intervention; currently there is no dominance between primary closure (which heals faster but suffers from increased recurrence) or healing via secondary intention. A discussion with the patient should be pursued to formulate the most ideal management. When primary closure is attempted, incisions in the midline should be avoided since they have higher recurrence and complication rates. Alongside surgery, prophylactic antibiotic therapy is often offered and depilation through laser therapy is recommended (shaving appears to increase recurrence rates). Lastly, in patients suffering from abscess formation, an incision and drainage procedure should be performed and healing followed by secondary intention alongside antibiotic cover and analgesic. In recurrent disease, a repeat of first line management is offered in both situations. More complex surgical techniques are often employed to compensate for the removal of midline tissues.
General surgery
Philip Stather, Helen Cheshire in Cases for Surgical Finals, 2012
Rubor – redness Dolor – pain Calor – warmth Tumour – swelling Function laesa – loss of functionHistory and examination Bloods – FBC, U+E, C-reactive protease (CRP) Swab – for cultureIncision and drainageBacterial contamination of surgical site Diabetes Previous abscess formation Immunosuppression Alcoholism ChemotherapyChronic abscess formationSinus formation Cellulitus Fistula formation Bacteraemia and sepsis An abscess is a collection of pus and both live and dead neutrophils, macrophages and bacteria. It may also include dead tissue. Cutaneous skin abscesses are usually rare following surgery but can occur spontaneously in obese, diabetic or immunosuppressed patients. The commonest bacterial contamination is with Staphylococcus aureus as it is normally present on skin, but antibiotics are not routinely given unless cellulitis is also present. Incision and drainage is curative. Inadequate drainage may lead to the build-up of granulation tissue and chronic abscess formation.
Pharyngitis
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Surgical drainage is the mainstay of treatment for PTA. Drainage of the abscess can be performed by either needle aspiration or an incision and drainage. Needle aspiration is the most common treatment in the UK.53 It is relatively pain-free, significantly contributes to pain relief compared with no aspiration54 and is not associated with any significant complications. However, complete pus drainage may be less reliable than with a quinsy knife thus potentially predisposing to greater recurrence risks and delayed complications. Quinsy knife drainage is mainly used when needle aspiration has failed but it is more painful than needle aspiration and has, historically, been associated with some disastrous complications. Incision and drainage are less painful if carried out with proper infiltration of local anaesthetic at the site of drainage rather than local anaesthetic spray.54
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
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.
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).
Related Knowledge Centers
- Abscess
- Antiseptic
- Iodine
- Paranasal Sinuses
- Pus
- Scalpel
- Sterilization
- Surgery
- Boil
- Peripherally Inserted Central Catheter