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COMMENTARY |
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Year : 2014 | Volume
: 7
| Issue : 6 | Page : 747-748 |
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Changing trends in abscess management
Shilpa Patankar
Department of Surgery, Bharti Vidyapeeth Medical College, Pune, Maharashtra, India
Date of Web Publication | 18-Nov-2014 |
Correspondence Address: Shilpa Patankar Department of Surgery, Bharti Vidyapeeth Medical College, Pune-Satara Road, Pune - 411 043, Maharashtra India
Source of Support: None, Conflict of Interest: None | Check |
How to cite this article: Patankar S. Changing trends in abscess management. Med J DY Patil Univ 2014;7:747-8 |
Abscess is the one of the most common surgical condition we treat in our day to day practice. An abscess is pus filled cavity, lined with pyogenic membrane. The pus is collection of dead white blood cells, multiplying bacteria, necrotic material, and toxins. Many times it consists of multiple loculi full of pus, which may or may not communicate with each other. If untreated it finds path of least resistance such as adjoining skin, or spreads along tissue planes, or erodes into an adjacent vessel.
The conventional treatment for an abscess is incision and drainage since the time of Sushruta in 600 BC. [1] This is based on the basic principle that infected wound should never be closed by primary intention as there is risk of recurrence. Therefore abscess wounds are left open and allowed to heal by granulation and re-epithelization (secondary intention). [2]
In the conventional method of abscess treatment, following incision and drainage, breaking the loculi with finger or sinus forceps, irrigation of the wound and gentle packing is recommended. Irrigation helps to reduce the bacterial load, while gentle packing prevents premature wound closure and allows continues drainage. However, packing increases pain and inconvenience to the patient. [3] Therefore with this treatment of repeated painful dressings, healing is delayed and bad scars are seen.
Aspiration of abscess has also been tried, but chances of recurrence are high as it does not break all the loculi as in conventional treatment.
However, Ellis in 1951 first described primary closure following incision and drainage, which he had done for anorectal abscess. [2] Following this, many trials were conducted in different countries around the world.
Primary closure technique for abscess depends on complete elimination of infection following incision and drainage, curettage of the abscess cavity and obliteration of the cavity. In earlier studies, the cavity was obliterated with deep vertical mattress sutures and corrugated drain kept. [4]
Now-a-days with the availability of negative suction drain this has been preferred as it is a closed drain and thus there is less chance of infection. Various trials have suggested that primary closure in abscess promotes healing, reduces pain and improves cosmetic scarring when compared to secondary healing.
However, further trials are needed on this subject as most of the trials included abscess of <5 cm in size, many of them were not site-specific and culture was not known in all cases. In Western literature, there is increase in incidence of methicillin-resistant Staphylococcus aureus causing abscess. [3]
Antibiotics play a crucial role in abscess, especially following primary closure. [5] Proper selection of antibiotics is necessary, which must be given in scheduled doses and time.
References | | |
1. | Dubey V, Choudhary SK. Incision and drainage versus incision and drainage with primary closure and use of closed suction drain in acute abscess. Wounds 2013;25:58-60. |
2. | Singer AJ, Thode HC Jr, Chale S, Taira BR, Lee C. Primary closure of cutaneous abscesses: A systematic review. Am J Emerg Med 2011;29:361-6. |
3. | Schmitz G, Goodwin T, Singer A, Kessler CS, Bruner D, Larrabee H, et al. The treatment of cutaneous abscesses: comparison of emergency medicine providers' practice patterns. West J Emerg Med 2013;14:23-8. |
4. | Khanna YK, Khanna A, Singh SP, Laddha BL, Prasad P, Jhanji RN. Primary closure of gluteal injection abscess (a study of 100 cases). J Postgrad Med 1984;30:105-10. [ PUBMED] |
5. | Hankin A, Everett WW. Are antibiotics necessary after incision and drainage of a cutaneous abscess? Ann Emerg Med 2007;50:49-51. |
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