Skin & Soft Tissue: Skin Abscess

Basics

• Definition: Purulent Fluid Collection within the Dermis & Subcutaneous Tissue
• Most Common Organism: Staphylococcus aureus
  • Majority Are Polymicrobial

Presentation

• Painful
• Fluctuant
• Erythematous Nodule
• May Have Surrounding Cellulitis

Diagnosis

• Clinical Diagnosis Based on Physical Exam
• Consider Ultrasound if Uncertain

Treatment

• Primary Treatment: Incision & Drainage (I&D)
• Antibiotic Indications:
  • Size ≥ 2 cm
  • Multiple Lesions
  • Extensive Surrounding Cellulitis
  • Sepsis/Systemic Toxicity (Fever, Tachycardia, Hypotension)
  • Immunosuppressed (Diabetes)
  • Prosthetic Devices
  • High Risk for Endocarditis
  • Failure of I&D Alone

Incision & Drainage (I&D)

• Procedure:
  • Make Incision Over the Most Prominent Area
    • If No Prominence is Identified – Incise Along the Most Dependent Area
  • Excise All Necrotic Tissue
  • Break All Loculations Using a Finger or Kelly Clamp
  • Consider Packing to Keep Allow Continued Drainage
• Most Common Complication: Bleeding