Incision and drainage

Diagnosis

1. May use US or needle aspiration
2. Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing

Differential Diagnosis

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Treatment

1. Antibiotics
   1. Give if there is a large cellulitic component or fever
   2. Need to cover staph and strep
2. Update Tetanus

Incision & Drainage

1. Be sure to document if packing was placed in the wound
2. Anesthesia should be lidocaine or Marcaine without epinephrine
3. Most patients need some pain medicine prior to procedure

• Beware of toxic dose of lidocaine!
• Lido lasts 30-90 min, bupivicaine (.25%) max= 2mg/kg lasts 6-8 hr. Do NOT inject bupivicaine intravascularly b/c= refractory cardiac arrest!!!

Follow-up

Wound check in 1-2 days and wound care sheet

See Also

• Lidocaine
• Bartholin Gland Abscess