Incision, drainage for soft tissue infections

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  • A localized collection of pus that is tender and is not resolving spontaneously
  • Facial furuncles located within the triangle formed by the bridge of the nose and the corners of the mouth
  • Local anesthetic (1% to 2% lidocaine) with sodium bicarbonate 7.5%, or diphenhydramine 50 mg/mL
  • Syringe with 25- to 30-gauge needle
  • Possibly a cryosurgery unit or ethyl chloride for anesthesia
  • Alcohol or povidone-iodine wipe
  • 4 × 4-inch gauze
  • No. 11 blade
  • Curved hemostats
  • Sterile cotton-tipped swabs (optional, to explore the abscess cavity)
  • Possibly iodoform packing gauze
  • Possibly culture materials
  • Bandage scissors
  • Dressing of choice
  • Sterile dermatology curette (if needed)
  • Epithelium
  • Dermis
    • Immediately adjacent to the epithelium, the dermis is less dense and contains terminal capillaries and nerve endings.
    • The next layer down is the papillary layer.
    • The reticular layer is the innermost and contains hair follicles, sweat glands, and sebaceous glands.

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  • Teach the patient or family member how to change the packing and replace the dressing.
  • Patients should be instructed to watch for recurrence or evidence of further infection.
  • Generally, bathing and frequent changes of the overlying dressing are encouraged.
  • Acetaminophen or NSAIDs may be needed for pain.
  • Complications include the following:
    • Recurrence
    • Scar or keloid
    • Failure to resolve, causing cellulitis, or progression to septicemia
    • Formation of a fistula
    • Osteomyelitis
  • Deep palmar infection
  • Recurrent paronychia
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