Superficial abscesses can be incised under local anaesthesia. Infiltration is started a short distance from the central, tender spot. A bleb in the skin is raised and the needle is gradually advanced. The anaesthetic is injected into the skin over the crest of the swelling. Five minutes is allowed for the local anaesthetic to take effect.
A small incision is made over the crest of the swelling and a specimen of the pus collected for culture and determination of antibiotic sensitivities. The inside of the cavity is then explored. If it is small, closed dissecting forceps or sinus forceps should be used. If it is large, a gloved finger may be inserted to examine the inside.
The contents of the abscess cavity are emptied using gentle suction, flushing with physiological saline or by swabbing. In some cases, such as a perianal abscess, a portion of the abscess wall is removed for histology, to aid in determining the cause of the abscess.
The hand offers particular difficulties in diagnosis and treatment. The pus may lie beneath thick, tense tissues through which it is difficult to detect the relatively small abscess. The tension causes severe pain, especially in the distal pulp space. It may be necessary to rely on finding the most tender spot. However, paronychia is obvious, as are web space infections. Subungual infections can often be drained by cutting or drilling a panel or hole out of the nail. Palmar space abscesses often produce oedema of the dorsum of the hand or tendon sheaths; these demand expert treatment.
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