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10. Medical and minor surgical procedures
Anaesthesia
W ith the excep tio n o f p aro ny chia, lo cal anaesthesia o f the abscess is usually im p o ssible.
G eneral anaesthesia m ay be ind icated , using:
ketamine IM : 1 0 m g/ k g
Technique
– Incision (F igure 8 a)
• H o ld the scalp el between the th um b and m id d le finger o f the d o m inant hand , the
ind ex finger p resses o n the hand le. H o ld the abscess between the thum b and ind ex
finger o f the o ther hand . T he scalp el blad e sho uld be p erp end icular to the sk in.
• T h e incisio n is m ad e in a single stro k e alo ng th e lo ng axis o f th e abscess. T h e
incisio n m ust be lo ng eno ugh fo r a finger to be inserted .
• B e cautio us when excising an abscess lo cated o ver a blo o d vessel (caro tid , axillary ,
hum eral, fem o ral, p o p liteal).
– Digital exploration (F igure 8 b)
• E xp lo re the cavity with the ind ex finger, break ing d o wn all lo culi (a single cavity
sho uld rem ain), evacuate the p us and exp lo re to the ed ges o f the cavity .
• T he exp lo ratio n also allo ws an assessm ent o f the extent o f the abscess, the d ep th,
and lo catio n w ith resp ect to und erly ing structures ( arterial p ulsatio n) o r any
p o ssible co ntact with und erly ing bo ne. I n this last case, seek surgical ad vice.
– Washing
A bund ant washing o f the cavity using a sy ringe filled with antisep tic so lutio n.
– Drainage (F igure 8 c)
Insert a d rain (o r, failing that a gauz e wick ) into the base o f the cavity . If p o ssible, fix
it to th e ed ge o f th e incisio n w ith a sing le suture. T h e d rain is w ith d raw n
p ro gressively and then, after 3 to 5 d ay s rem o ved co m p letely .
10
Figure 8a
Incisio n with a scalp el
275
Anaesthesia
W ith the excep tio n o f p aro ny chia, lo cal anaesthesia o f the abscess is usually im p o ssible.
G eneral anaesthesia m ay be ind icated , using:
ketamine IM : 1 0 m g/ k g
Technique
– Incision (F igure 8 a)
• H o ld the scalp el between the th um b and m id d le finger o f the d o m inant hand , the
ind ex finger p resses o n the hand le. H o ld the abscess between the thum b and ind ex
finger o f the o ther hand . T he scalp el blad e sho uld be p erp end icular to the sk in.
• T h e incisio n is m ad e in a single stro k e alo ng th e lo ng axis o f th e abscess. T h e
incisio n m ust be lo ng eno ugh fo r a finger to be inserted .
• B e cautio us when excising an abscess lo cated o ver a blo o d vessel (caro tid , axillary ,
hum eral, fem o ral, p o p liteal).
– Digital exploration (F igure 8 b)
• E xp lo re the cavity with the ind ex finger, break ing d o wn all lo culi (a single cavity
sho uld rem ain), evacuate the p us and exp lo re to the ed ges o f the cavity .
• T he exp lo ratio n also allo ws an assessm ent o f the extent o f the abscess, the d ep th,
and lo catio n w ith resp ect to und erly ing structures ( arterial p ulsatio n) o r any
p o ssible co ntact with und erly ing bo ne. I n this last case, seek surgical ad vice.
– Washing
A bund ant washing o f the cavity using a sy ringe filled with antisep tic so lutio n.
– Drainage (F igure 8 c)
Insert a d rain (o r, failing that a gauz e wick ) into the base o f the cavity . If p o ssible, fix
it to th e ed ge o f th e incisio n w ith a sing le suture. T h e d rain is w ith d raw n
p ro gressively and then, after 3 to 5 d ay s rem o ved co m p letely .
10
Figure 8a
Incisio n with a scalp el
275
