Wednesday, April 21, 2021

Incision and drainage

 Incision and drainage (Hilton's Method)


REQUIREMENTS: Written informed consent, sterile gauze pieces, povidone-iodine, ethanol, sterile drape, syringe with needle filled with local anesthetic drug, scalpel with no.11 blade, 2 sterile syringes or 1 sterile syringe and 1 sterile swab, pre-labelled containers (for sending the sample for microscopy and culture and sensitivity), artery/ sinus forceps, roller gauze

• Area of abscess is cleaned with povidone iodine followed by ethanol and draped
• Local anesthesia (generally lignocaine) is injected
• Stab incision along long axis of abscess with no.11 blade is made over the most prominent part of the
swelling where the skin is red, thinned out & pointed OR over the most dependent part of abscess (to allow easy drainage)
• Skin incision is generally made along the Langer’s lines (vertically on limbs and horizontally on trunk) and it should be parallel to neurovascular bundle
• Squeeze out the pus
• Sample is collected by a syringe/ swab for microscopy and culture & sensitivity in a prelabelled sterile
• Explore the abscess cavity by introducing sinus forceps/ finger in the abscess cavity and breaking all loculi
• Base of the abscess, if unhealthy, is curetted
• Oozing of fresh blood indicates completion of process
• Cavity is irrigated by normal saline followed by antiseptic (e.g. Povidone-Iodine and H2O2)
• Pack the cavity with roller gauze (soaked in Povidone-iodine) and remove it after 24-48 hrs
• Keep the abscess open and do regular dressing. Allow healing by secondary intention
• Advice to patient: Keep the area clean and dry


Alternate day dressings (generally). Analgesics SOS.
Antibiotics and Tetanus immunization as indicated.

1. Incision should be large enough to allow artery forceps to enter. If required, extension of incision in the same axis may be done or a cruciate incision can be made
2. Sometimes a counter incision can be made in a the independent part to allow gravity- assisted drainage
3. Overpacking of abscess cavity should be avoided (to prevent ischemia of surrounding tissue)

Abscess at special sites:
I. For breast abscess, needle aspiration is done rather than incision and drainage. If it has to be done, incision should be radial
II. For some abscess like axillary abscess, drainage should be done under general anesthesia
III. Gluteal abscess requires a cruciate incision and de-roofing
IV. Tubercular lymph nodal abscesses are drained by non-dependent aspiration (To prevent non-healing of incision site)


Equipment required: 2:28min
Preparation: 3:39 min
Procedure: 4:46 min to 7:27 min


Written by our guest authors Tushar Mahajan and Anveshi Nayan
Illustrations by Devi Bavishi


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