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Incision and drainage, or I&D, is a common treatment for an abscess. An abscess, or infection with pus, may not heal well on its own or even with antibiotics. The pus usually needs to be drained to promote healing.

An I&D is performed by first numbing the area around the abscess with local anesthetic. A scalpel or needle is inserted into the skin overlying the pus and the pus is drained. Many abscesses have pockets of pus that must be broken up to release all of the pus.

Sometimes a wick, usually a piece of gauze or gauze tape, is placed in the drained abscess to keep the skin from closing. This allows the wound to continue to drain as it heals from the inside out.

An abscess is a simple collection of necrotic tissue in a liquefied status; most often infected (with purulent material-pus). Apart from the local symptoms of pain, swelling, redness and limitations of movements due to the location, systemic symptoms like fever are not uncommon.

The best treatment for any abscess or collection of pus is to drain the same with a liberal incision with dependent drainage. Once an abscess reaches the stage of collection of purulent material in liquefied status it is seldom possible to treat with antibiotics or by any other means.

An abscess can be located anywhere in the body and can present challenging clinical situations when located inside the abdomen, flank, chest, brain and tissues deeper to the facia etc. These abscesses have to be evaluated on the basis of the presenting signs and symptoms and also ustilising the advanced modalities of imaging.

In most situations the nature of infection and the organisms can be detected by clinical reasoning and appropriate empiric broad spectrum antibiotic therapy can be started just before or after the incision and drainage while awaiting specific culture reports. Suitable modifications on the antibiotic regimen can then be made on the basis of the report.

In certain locations like face, it is occasionally possible to manage small abscesses by needle aspiration and antibiotic therapy to help avoid scars in the face. But, this has to be carefully planned and evaluated and utilised only in circumstances where it is possible to handle by this method. If the pus is thick and not possible to aspirate well, prompt incision and drainage should be undertaken.

Occasionally, to promote adequate drainage particularly from deep pockets, corrugated rubber drains are placed and gauze packing is utilised to prevent premature closure before all the pus is drained and for healing to take place from the bottom. Each abscess has to be dealt with according to its location, extent, depth and presence or absence of vital tissues like blood vessels and nerves in the area.

Diagnosis of abscess may sometimes be difficult and particularly where normal blood vessels are expected, difficulties in differentiating between pulsatile hematoma, abscess, aneurysm etc may occur. In such circumstances, if by clinical diagnostic methods, one is unable to come to a conclusion, a preliminary 22 gauge or 23 gauge needle aspiration of the swelling may be considered before incision and drainage is done. If the aspirate is purulent, incision and drainage can be performed. On the other hand if it is blood, needle is withdrawn, some pressure is applied for a few minutes and then further testing is carried out before specific treatment is given.