Consent: Incision and Drainage of an Abscess

Original Author: Ollie Jones
Last Updated: February 19, 2019
Revisions: 10

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

Abscess drainage is often one of the first procedures a junior doctor will perform. It involves making an incision into the abscess, breaking down the loculated areas, and washing out the pus as thoroughly as possible.

The wound is never closed, but left open with a wick (typically ribbon gauze or kaltostat) to keep the wound open and allow any remaining infection to drain, after which the wound heals by secondary intention.

Complications

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Bleeding Typically there is minimal blood loss, however groin abscesses can often involve the femoral artery which causes profuse haemorrhage. Be aware of underlying blood vessels and seek advice from a vascular surgeon if concerned of vascular involvement
Damage to other structures This is particularly relevant in peri-anal abscesses where extreme care must be taken to avoid damaging the anal sphincter complex. Axillary and groin abscess surgery also poses the risk of damage to underlying major vessels or nerves Always do circum-anal incisions (unless an experienced colorectal surgeon) to avoid the risk of sphincter damage
Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain Patients typically report less pain post procedure, however simple pain killers orally will often be required post-operatively.
Bleeding There is a small chance of bleeding and bruising post operatively.
Infection Superficial wound infection and further abscess formation is possible, which may necessitate further washout and debridement or a course of antibiotics.
Scarring Any incision will result in a scar, which may form a keloid scar, particularly in high risk ethnicities. Leaving these wounds to heal by secondary intention results in a poorer scar. Where appropriate, wounds should be packed to prevent healing by secondary intention (these can be removed by community nurses post-discharge)
Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.

Late

Complication Description of Complication Potential Ways to Reduce Risk
Recurrence If locules are left, the abscess can recur and require re-intervention

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