The doctor decides the modality of treatment based on the size and location of an abscess. These include non-surgical, antibiotic-based treatments to a simple drainage procedure and finally surgery.
Abscess drainage: Skin
An abscess formed on the skin may drain naturally without requiring a doctor to attend to them. Applying gentle heat such as warm water compress will alleviate the pain and eventually have the abscess drain by itself.
In the case of recurrent infections, the doctor may consider incision and drainage. This is primarily because the abscess may be showing the tendency to grow in size and become painful and antibiotics and home-based techniques are not sufficient to rid the body of the infection.
When draining the abscess, an incision is performed under local anesthesia. The patient is awake throughout the procedure, but the area to be treated is numbed.
The doctor makes a small incision at an appropriate location on the skin of the abscess, allowing the pus underneath to drain. A sample from the oozing pus may be sent to the laboratory for the investigation of the microbial content.
Once drained, the doctor irrigates the now formed hole (because of the abscess) with saline to thoroughly clean and ensure there is no pus remaining to prevent reinfection.
The drained region is covered with a dressing to facilitate any further drainage. In the case of a deep abscess, the doctor may place an antiseptic gauze wick to keep the wound open and facilitate complete drainage followed by recovery.
The doctor will instruct home care for the patient and the next visit for dressing and evaluation of healing. The procedure typically leaves a small scar after healing.
Abscess drainage: Internal abscess:
Here the abscess formation, as the name suggests, is within the body. The size and extent of the abscess decide if the doctor will resort to percutaneous drainage (achieved by inserting a needle through a small cut on the skin and layers below to reach the abscess) or surgery.
This modality of treatment involves the parallel use of antibiotics to curb the underlying cause of the infection. These could be orally administered antibiotics or given through the intravenous (IV) route.
The surgeon detects the size and location of the abscess using imaging techniques, such as ultrasound or CT scans. The doctor decides the type of anesthesia; it could be local or general.
Once the abscess has been located the surgeon makes a small incision on the skin positioned appropriately to approach the needle into the abscess.
A fine needle is used to drain a small abscess. If the abscess is larger, the surgeon inserts a drainage catheter (small plastic tube). This facilitates the drainage of the collected pus. It can be left in that position for a week to ensure it's completely drained.
Although it is a day-based procedure, depending on the size of the abscess the patient may have to stay at the hospital for a few days.
This procedure too leaves a small incisional scar on the skin.
The doctor recommends this option only when:
Needle drainage can be cumbersome as the abscess is too large.
The abscess cannot be safely approached using a needle.
To prevent recurrent infection, needle drainage may not effectively drain all the pus.
The type of surgery and the size of the incision is defined by the location of the abscess. It is performed under general anesthesia and a larger incision is made into the skin to facilitate complete washing of the abscessed internal region.
This will be followed by a stay at the hospital for evaluation and until the patient is stable to be sent back home.
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