The Principles of Incision & Draining of an Abscess:
Picture – Assess and evaluate the abscess and surrounding anatomy.
Prep – clean and prep the area of the skin to be incised.
Pain control – if possible numb the skin with ice or inject with lidocaine.
Puncture the abscess – with a scalpel or sharp knife pierce the abscess.
Purge – gently compress and drain the abscess.
Purify – rinse the abscess clean with iodine solution.
Protect – cover with a sterile dressing and monitor during evacuation.
Stitches & Wound Closure:
- Wounds edges may be approximated but, they should not be closed unless the wound can be thoroughly cleaned and closed in sterile fashion.Wound repair and closure is rarely functional; it is almost always cosmetic.If a wound heals with a scar, the scar can later be removed and the wound sutured closed for a better result.
Bite wounds should never be closed as they are very dirty wounds, from the bacteria from the animal’s mouth.
Always consider tetanus booster for dirty wounds. Tetanus immunization is good for 10 years.
Always consider rabies prophylaxis for animal bites.
So, in the wilderness setting:
Properly and thoroughly scrub and clean the wound.
Approximate the edges, but do not close the wound.
Dress and bandage the wound to protect and promote healing.
With loss of function splint to support the extremity.
Change dressings at least two times per day.
Monitor for signs of infection.
If the wound is going to continue to get wet, use iodine wet-to-dry dressings to prevent infection.
For more detailed information on wilderness and long-term management of Soft Tissue Injuries see the Jan/Feb 2006 and the March/April 2006 issues of the Wilderness Medicine Newsletter.