Dear Mr. Rawles:
A few comments, in no particular order, regarding the recent article “How to Drain an Abscess, by Lonestar Doc”.
Lonestar Doc is absolutely correct that an incision and drainage (I&D) should be handled by someone with the appropriate training and experience to perform the procedure. However if you are in a situation where you as a non-medical person need to drain an abscess, such as described by Lonestar Doc, it is important to proceed with the I&D whether you have Lidocaine for anesthesia or not. The pain of an I&D without anesthesia does not outweigh the need to drain the infection, which in the most extreme circumstance could be life-threatening.
If you do have Lidocaine on hand, look to see if you have Lidocaine with epinephrine or plain Lidocaine (no epinephrine). The bottle will be clearly labeled as “with epinephrine” and the label will usually be red. Lidocaine with epinephrine must not be used on small digits and body parts, usually taught to medical students as the rhyme “fingers, toes; ears and nose”. The epinephrine constricts the small arterial blood vessels and decreases bleeding but in these small areas it can decrease blood supply enough that the area dies.
If an abscess is larger in diameter than 5 cm (about 2-½ inches) my surgeons and wound care consultants will still leave a loose packing of gauze, changing it every 1-2 days. Leave a small amount of the gauze sticking up out of the incision so you can grab it for removal. Use smaller amounts of gauze every time the packing is changed to allow for healing from the inside out. Packing the site too tightly causes pressure on the underlying tissues which may cause it to die. [Necrosis.] Use loose packing.
If an abscess has already started to drain but still feels fluctuant or “squishy” you may need to make an incision to provide better drainage of the pus. The process is the same; just incorporate the draining site in the incision since that’s where the pus is already concentrated.
When making the incision, you don’t have to bury to entire scalpel blade and handle in the abscess. A small stab and then draw the blade through the skin to make the cut will help to keep the blade out of deeper tissues. Make the incision long enough to allow good drainage from the abscess without leaving a hole the size of the Grand Canyon. If you have an abscess 4 cm in diameter, a tiny puncture wound the size of a pencil lead isn’t going to give you enough drainage. If you make the incision too big you will get into normal tissue and have a lot of unnecessary bleeding and tissue damage. Try to make the incision along the skin lines to help with healing of the incision site. To find the skin lines, gently pinch up about 1-2 inches of skin. Whichever way the skin makes folds is the way the skin lines run.
If you don’t have a scalpel, then a #11 X-Acto knife
Lastly, as with most medical problems, prevention is more desirable than treatment. Good hand washing, don’t pick your nose and wash your body regularly with soap are all important strategies in avoiding abscesses. – Ladydoc