We see many skin infections here at BMC. Many have progressed to abscesses and boils. These are collections of pus that have been walled off or encapsulated. They are usually exquisitely tender due to the pressure. The treatment for such is to lance it open – incision and drainage (I&D).
Sometimes, there are loculated pockets of pus which must be probed and opened in order to allow proper drainage. Often, I&D is the only treatment needed, but antibiotics can also be given if it is likely that the surrounding skin will get infected. Local anesthetic doesn’t work very well because the acidity of the abscess, so the procedure is somewhat painful. I have done quite a few I&D’s here, on fingers, hands, legs, buttocks, groins, etc. Yesterday, I had a patient with a very tender boil in his armpit. He said that he had been traveling in cramped quarters for the past couple days.
I sent him down to the theater and set up for an I&D. I asked one of the theater staff to take a photo of me doing the procedure to put on the blog. Some patients are very stoic, others cry and scream throughout, and one lady had a baby nursing while I lanced her abscess. My patient yesterday was very calm and handled it like a champ.
Click to see the photos…but be warned if you don’t like pus.