Cutaneous abscess surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
===Aspiration=== | |||
Ultrasonographically guided needle aspiration is not sufficient.<ref name="pmid21239082">{{cite journal| author=Gaspari RJ, Resop D, Mendoza M, Kang T, Blehar D| title=A randomized controlled trial of incision and drainage versus ultrasonographically guided needle aspiration for skin abscesses and the effect of methicillin-resistant Staphylococcus aureus. | journal=Ann Emerg Med | year= 2011 | volume= 57 | issue= 5 | pages= 483-91.e1 | pmid=21239082 | doi=10.1016/j.annemergmed.2010.11.021 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21239082 }} </ref> | |||
===Incision and drainage=== | ===Incision and drainage=== | ||
{{main|Incision and drainage}} | {{main|Incision and drainage}} | ||
===Video on incision and drainage of an abscess=== | |||
{{#ev:youtube|MwgNdrA18fM}} | |||
The abscess should be inspected to identify if foreign objects are a cause, requiring surgical removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics. | The abscess should be inspected to identify if foreign objects are a cause, requiring surgical removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics. | ||
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===Primary closure=== | ===Primary closure=== | ||
This topic has been studied by [[systematic review]].<ref name="pmid20825801">{{cite journal| author=Singer AJ, Thode HC, Chale S, Taira BR, Lee C| title=Primary closure of cutaneous abscesses: a systematic review. | journal=Am J Emerg Med | year= 2011 | volume= 29 | issue= 4 | pages= 361-6 | pmid=20825801 | doi=10.1016/j.ajem.2009.10.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20825801 }} </ref> | |||
{| class="wikitable" | {| class="wikitable" | ||
|+ [[Randomized controlled trial]]s of primary closure.<ref name="pmid6805714">{{cite journal |author=Simms MH, Curran F, Johnson RA, ''et al'' |title=Treatment of acute abscesses in the casualty department |journal=British medical journal (Clinical research ed.) |volume=284 |issue=6332 |pages=1827-9 |year=1982 |pmid=6805714 |doi=}}</ref> | |+ [[Randomized controlled trial]]s of primary closure of non-anorectal skin abscesses.<ref name="pmid322789">{{cite journal| author=Macfie J, Harvey J| title=The treatment of acute superficial abscesses: a prospective clinical trial. | journal=Br J Surg | year= 1977 | volume= 64 | issue= 4 | pages= 264-6 | pmid=322789 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=322789 }} </ref> <ref name="pmid6805714">{{cite journal |author=Simms MH, Curran F, Johnson RA, ''et al'' |title=Treatment of acute abscesses in the casualty department |journal=British medical journal (Clinical research ed.) |volume=284 |issue=6332 |pages=1827-9 |year=1982 |pmid=6805714 |doi=}}</ref> <ref name="pmid3881155">{{cite journal |author=Stewart MP, Laing MR, Krukowski ZH |title=Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial |journal=The British journal of surgery |volume=72 |issue=1 |pages=66-7 |year=1985 |pmid=3881155 |doi=}}</ref> <ref name="pmid9137156">{{cite journal |author=Abraham N, Doudle M, Carson P |title=Open versus closed surgical treatment of abscesses: a controlled clinical trial |journal=The Australian and New Zealand journal of surgery |volume=67 |issue=4 |pages=173-6 |year=1997 |pmid=9137156 |doi=}}</ref> <ref name="Singer">Singer et al. (2013)Primary Versus Secondary Closure of Cutaneous Abscesses in the Emergency Department: A Randomized Controlled Trial. Acad Emerg Med{{doi|10.1111/acem.12053}}</ref> | ||
<ref name="pmid3881155">{{cite journal |author=Stewart MP, Laing MR, Krukowski ZH |title=Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial |journal=The British journal of surgery |volume=72 |issue=1 |pages=66-7 |year=1985 |pmid=3881155 |doi=}}</ref> <ref name="pmid9137156">{{cite journal |author=Abraham N, Doudle M, Carson P |title=Open versus closed surgical treatment of abscesses: a controlled clinical trial |journal=The Australian and New Zealand journal of surgery |volume=67 |issue=4 |pages=173-6 |year=1997 |pmid=9137156 |doi=}}</ref> <ref name="Singer">Singer et al. (2013)Primary Versus Secondary Closure of Cutaneous Abscesses in the Emergency Department: A Randomized Controlled Trial. Acad Emerg Med{{doi|10.1111/acem.12053}}</ref> | |||
! rowspan="2"|Trial!!rowspan="2"| Patients!!rowspan="2"| Intervention!!rowspan="2"|Comparison !!rowspan="2"|Outcome!!colspan="2"|Results!!rowspan="2"|Comment | ! rowspan="2"|Trial!!rowspan="2"| Patients!!rowspan="2"| Intervention!!rowspan="2"|Comparison !!rowspan="2"|Outcome!!colspan="2"|Results!!rowspan="2"|Comment | ||
|-<br/> | |-<br/> | ||
! Intervention!!Control | ! Intervention!!Control | ||
|- | |||
| Mcfie<ref name="pmid322789"/><br/>1977|| 219 patients|| Primary closure (factorial design with/without antibiotics)|| || || || || No differences among four study groups | |||
|- | |- | ||
| Simms<ref name="pmid6805714"/><br/>1982|| 114 patients|| Primary closure|| || Various outcomes|| || || Primary closure delayed healing by one day | | Simms<ref name="pmid6805714"/><br/>1982|| 114 patients|| Primary closure|| || Various outcomes|| || || Primary closure delayed healing by one day | ||
Latest revision as of 14:10, 27 March 2017
|
Abscess Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Wound abscesses do not generally need to be treated with antibiotics, but they will require surgical intervention, debridement and curretage.[1]
Surgery
Aspiration
Ultrasonographically guided needle aspiration is not sufficient.[2]
Incision and drainage
Video on incision and drainage of an abscess
{{#ev:youtube|MwgNdrA18fM}} The abscess should be inspected to identify if foreign objects are a cause, requiring surgical removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics.
Surgical drainage of the abscess (e.g. lancing) is usually indicated once the abscess has developed from a harder serous inflammation to a softer pus stage. This is expressed in the Latin medical aphorism Ubi pus, ibi evacua.
In critical areas where surgery presents a high risk, surgery may be delayed or used as a last resort. The drainage of a lung abscess may be performed by positioning the patient in a way that enables the contents to be discharged via the respiratory tract. Warm compresses and elevation of the limb may be beneficial for skin abscess.
Primary closure
This topic has been studied by systematic review.[3]
| Trial | Patients | Intervention | Comparison | Outcome | Results | Comment | |
|---|---|---|---|---|---|---|---|
| Intervention | Control | ||||||
| Mcfie[4] 1977 |
219 patients | Primary closure (factorial design with/without antibiotics) | No differences among four study groups | ||||
| Simms[5] 1982 |
114 patients | Primary closure | Various outcomes | Primary closure delayed healing by one day | |||
| Stewart[6] 1985 |
137 patients • All abscesses were drained, curetted, and irrigated |
Primary closure | Various outcomes | Primary closure significantly better | |||
| Abraham[7] 1997 |
61 patients • "Abscesses requiring drainage under a general anaesthetic" • All abscesses were drained, curetted, and irrigated |
Primary closure with interrupted vertical mattress skin sutures with/without closed suction drainage | Packing | • Healing at one week • Healing at one month |
Primary closure significantly better at one week; no difference at one month. | ||
| Singer[8] 2013 |
56 patients | Primary closure with vertical mattress sutures | Packing | Failure to health at one week | 30% | 29% | Primary closure significantly better |
In anorectal abscesses, primary closure healed faster, but 25% of abscesses healed by secondary healing and recurrence was higher.[9]
Perianal abscess
Perianal abscesses can be seen in patients with for example inflammatory bowel disease (such as Crohn's disease) or diabetes. Often the abscess will start as an internal wound caused by ulceration or hard stool. This wound typically becomes infected as a result of the normal presence of feces in the rectal area, and then develops into an abscess. This often presents itself as a lump of tissue near the anus which grows larger and more painful with the passage of time.
Like other abscesses, perianal abscesses may require prompt medical treatment, such as an incision and debridement or lancing.
References
- ↑ McLatchie G, Leaper D, (eds). 2007. Oxford Handbook of Clinical Surgery, 2nd ed. Oxford. OUP
- ↑ Gaspari RJ, Resop D, Mendoza M, Kang T, Blehar D (2011). "A randomized controlled trial of incision and drainage versus ultrasonographically guided needle aspiration for skin abscesses and the effect of methicillin-resistant Staphylococcus aureus". Ann Emerg Med. 57 (5): 483–91.e1. doi:10.1016/j.annemergmed.2010.11.021. PMID 21239082.
- ↑ Singer AJ, Thode HC, Chale S, Taira BR, Lee C (2011). "Primary closure of cutaneous abscesses: a systematic review". Am J Emerg Med. 29 (4): 361–6. doi:10.1016/j.ajem.2009.10.004. PMID 20825801.
- ↑ 4.0 4.1 Macfie J, Harvey J (1977). "The treatment of acute superficial abscesses: a prospective clinical trial". Br J Surg. 64 (4): 264–6. PMID 322789.
- ↑ 5.0 5.1 Simms MH, Curran F, Johnson RA; et al. (1982). "Treatment of acute abscesses in the casualty department". British medical journal (Clinical research ed.). 284 (6332): 1827–9. PMID 6805714.
- ↑ 6.0 6.1 Stewart MP, Laing MR, Krukowski ZH (1985). "Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial". The British journal of surgery. 72 (1): 66–7. PMID 3881155.
- ↑ 7.0 7.1 Abraham N, Doudle M, Carson P (1997). "Open versus closed surgical treatment of abscesses: a controlled clinical trial". The Australian and New Zealand journal of surgery. 67 (4): 173–6. PMID 9137156.
- ↑ 8.0 8.1 Singer et al. (2013)Primary Versus Secondary Closure of Cutaneous Abscesses in the Emergency Department: A Randomized Controlled Trial. Acad Emerg Meddoi:10.1111/acem.12053
- ↑ Kronborg O, Olsen H (1984). "Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 3-year follow-up". Acta Chirurgica Scandinavica. 150 (8): 689–92. PMID 6397949.