The following treatment guidelines apply to abscesses of the buttock, thighs and upper arms. Surgical consult is suggested for abscesses that are in close proximity to neurovascular, ligament and tendon structures or have potential cosmetic concerns.
- Provide pain manage per procedural sedation and analgesia treatment. Moderate sedation will likely be needed for infants and children. Adolescents may only require analgesia treatment. Local infiltration of 1% lidocaine is usually ineffective.
- Prep area with povidone-iodine solution times three and alcohol wipe times one.
- Define the edges of the abscess.
- Incise the abscess with a #11 scalpel blade from edge to edge of the abscess along a line the parallels the nature skin lines.
- Undermine the edges of the abscess with a blunt edged hemostat.
- Consider culturing the wound, especially for patients at risk for immune deficiency disorders.
- Pack the wound with gauze and apply dressing.
- If cellulitis is associated with the abscess or MRSA is the likely etiology, prescribe a 5 to 7 day course of an appropriate antibiotic.
- Complete ABSCESS MANAGEMENT discharge instructions. Recommend home care or follow up with the patient's physician. Follow up in the ED will not be necessary in the majority of patients.