Incision

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Incision Drainage of an Axillary Abscess

• Jaclyn Augustensen

2
Case Presentation

• 14 y/o male presented to ER w/CC of pain and a
  red area in his left axilla
• Had a pimple there 3 days prior and picked at
  it, now increasingly more painful and swollen
• Rated pain 5/10, had no other areas like this
  one, never had anything like this before
• Review of systems unremarkable

3
On Exam

• Patient alert, oriented in no acute distress
• Afebrile
• The area of complaint revealed an approximate
  10cm tender erythematous fluctuant abscess in the
  left axilla

4
The Procedure- Incision and Drainage

• A suture kit, 11 blade, 1 Lidocaine, and
  betadine were gathered
• The area was prepped with betadine followed by a
  field block with the 1 Lidocaine
• Sterile gloves were applied and a 2.5cm incision
  was made in the center of the abscess
• The contents were pushed out and a sample was
  taken for culture
• 30ccs of purulent material was drained
• The empty cavity was then filled with sterile
  packing and wound was dressed

5
Background on Skin Absess

• Occur when an area of tissue becomes infected
• Body attempts to isolate the infection
• White blood cells (pus) migrate through the walls
  of blood vessels into the area and collect
• Pus is an accumulation of fluid, living dead
  WBCs, dead tissue, and bacteria

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More Background

• Can form almost anywhere but appear quite
  frequently in the anorectal, peritonsillar,
  tooth, and axillary regions
• Present as red, raised, painful areas that if
  left untreated can prevent deeper tissues from
  functioning properly
• The infection may spread locally or throughout
  the body if the blood or surrounding lymph nodes
  become infected

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Bacteria in an Abscess

• Our patients abscess was infected with MRSA, or
  Methicillin-resistant Staphylococcus aureus
• MRSA is emerging as the predominant cause of skin
  and soft tissue infections in emergency
  departments across the USA
• Is not susceptible to beta-lactam anti-staph
  agents

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Treatment for a MRSA abscess

• DOC- Trimethoprim-sulfamethoxazole (Bactrim)
  160mg b.i.d. x 14 days
• Other drugs that could be used are Vancomycin and
  Linezolid

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Patient Education Follow-up

• At 2 days post ID the patient is to return for a
  wound check
• The soiled packing is to be removed from the
  empty cavity and either replaced with new or, at
  the clinicians discretion, left to fill in
  naturally
• Patient is instructed to follow-up with his/her
  family doctor in 12 days to assure full recovery
• The importance of completing the full course of
  antibiotics must be stressed
• Patient instructed to return to the ER if the
  area becomes infected or if another abscess forms

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Differential

• Furuncle- red, rapidly enlarging papule on hairy
  skin
• Carbuncle- More extensive than furuncle, infected
  hair follicle
• Epidermal cyst- inflamed, not infected