Incision and drainage (I&D), also known as clinical lancing, are minor
surgical procedure
Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...
s to release
pus or pressure built up under the skin, such as from an
abscess
An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...
,
boil
A boil, also called a furuncle, is a deep folliculitis, which is an infection of the hair follicle. It is most commonly caused by infection by the bacterium ''Staphylococcus aureus'', resulting in a painful swollen area on the skin caused by ...
, or infected
paranasal sinus
Paranasal sinuses are a group of four paired skeletal pneumaticity, air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the Ethmoid sinus, ethmoidal sinuses a ...
. It is performed by treating the area with an
antiseptic
An antiseptic ( and ) is an antimicrobial substance or compound that is applied to living tissue to reduce the possibility of sepsis, infection, or putrefaction. Antiseptics are generally distinguished from ''antibiotics'' by the latter's abil ...
, such as
iodine
Iodine is a chemical element; it has symbol I and atomic number 53. The heaviest of the stable halogens, it exists at standard conditions as a semi-lustrous, non-metallic solid that melts to form a deep violet liquid at , and boils to a vi ...
-based solution, and then making a small incision to puncture the skin using a
sterile instrument such as a sharp needle or a pointed
scalpel
A scalpel or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various handicrafts. A lancet is a double-edged scalpel.
Scalpel blades are usually made of hardened and tempered ...
. This allows the pus to escape by draining out through the incision.
Good medical practice for large abdominal abscesses requires insertion of a drainage tube, preceded by insertion of a
peripherally inserted central catheter line to enable readiness of treatment for possible
septic shock.
Adjunct antibiotics
Uncomplicated cutaneous abscesses do not need antibiotics after successful drainage.
In incisional abscesses
For
incisional abscesses, it is recommended that incision and drainage is followed by covering the area with a thin layer of
gauze
Gauze is a thin, translucent Textile, fabric with a wikt:loose, loose open Weaving, weave. In technical terms, "gauze" is a weave structure in which the weft yarns are arranged in pairs and are crossed before and after each Warp (weaving), w ...
followed by sterile
dressing. The dressing should be changed and the wound irrigated with normal saline at least twice each day.
In addition, it is recommended to administer an
antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...
active against staphylococci and streptococci, preferably
vancomycin
Vancomycin is a glycopeptide antibiotic medication used to treat certain bacterial infections. It is administered intravenously ( injection into a vein) to treat complicated skin infections, bloodstream infections, endocarditis, bone an ...
when there is a risk of
methicillin-resistant ''Staphylococcus aureus''.
The wound can be allowed to close by
secondary intention. Alternatively, if the infection is cleared and healthy
granulation tissue
Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size ...
is evident at the base of the wound, the edges of the incision may be reapproximated, such as by using
butterfly stitches,
staples or
sutures.
See also
*
Drain (surgery)
*
References
{{Surgery
Surgical procedures and techniques