INCISION AND DRAINAGE OF SUPERFICIAL LESIONS. PREVENTIVE AND CURATIVE DRAINAGE Bogdan Stancu

Learning objectives What you should know  What is a scalpel  What are the types of scalpel blades used  How to use a scalpel  Classification of incisions  What is surgical drainage  What are the indications of surgical drainage  Drainage modalities  What type of drains to use  When to remove drains

What you should do  Choose the materials required for incision and drainage  Check the identity of the patient undergoing incision/drainage  Open the package of a scalpel blade  Mount a scalpel blade on the handle  Perform a skin incision  Perform an abscess incision  Place a drain  Maintain the sterility of materials throughout the procedure  Dismount a blade from the scalpel handle  Throw the blade to the container for sharp objects

Definition Incision represents a cut into superficial or deep tissues using a sharp instrument (scalpel) in order to create direct surgical access for exposure of anatomical elements (arteries, veins, nerves, tendons, muscles), approach of an internal organ, drainage of an abscess, removal of a foreign body or a tumor, performance of biopsy, or excision of scar or necrotic tissues. Drainage is a surgical procedure that is usually complementary to a more or less extensive surgery, whose aim is to remove pathological or potentially pathological collections that Indications of incision:          

Contraindications of incision:    

Drainage of superficial lesions Preventive drainage – Indications:      Curative drainage – “ ” Indications:      

Elements of anatomy

Materials required for incision      ’    

Materials required for drainage   ’     ’      

Incision technique The identity is checked is positioned Asepsis of the surgical field    Anesthesia:   on the side of the lesion Placement of the incision      Handling of the scalpel:      ’        Incision for panaritia is made on the lateral side of the digit, at the limit between palmar and dorsal skin, the incision line being discontinued at joint level. Hemostasis is performed by electrocautery or by ligation. Incision by electrocautery is indicated to obtain aesthetic scars (face, neck) as well as to open highly septic collections (anthrax, gas gangrene, diffuse phlegmon). Wound dressing is finally applied.

Superficial lesion drainage technique The identity of the patient undergoing drainage is checked. Asepsis of the surgical field:  Hair shaving in the area concerned  Application of antiseptic solutions to the skin  Isolation of the area with sterile drapes Anesthesia:  Local or locoregional with lidocaine 1%;  For more extensive or deeper lesions, spinal or general anesthesia is preferred. The surgeon is positioned on the side of the lesion, facing one or two assistants. An incision of superficial lesions is performed. Drainage involves placing a drain through the wound or the counterincision in the residual cavity at the most declivous site, following gravity. Drains are provided with multiple orifices, which must be Figure 1. Placement of a drain for situated inside the residual cavity. preventive purposes The drain should be adapted to a given situation regarding thickness and length, so as not to get clogged, and it should be sufficiently rigid not to collapse. The drain is secured by ligation following skin Figure 2. Placement of a drain by suturing. counterincision for curative purposes rubber sheets –

Incidents and accidents of incision         Incidents and accidents of drainage  Ineffective drainage because of its inadaptation to the given situation (thickness, length, orifices)  Hemorrhage from the residual cavity or from injury to adjacent blood vessels  Breakage of the drain and its loss in the drained cavity  Contamination of the residual cavity from the external environment because of non-compliance with asepsis rules. Assessment / self-assessment form

1. Incision Stage / Criterion Correct Incorrect Check the identity of the patient undergoing incision, explain the procedure, and position the patient Materials required for incision Asepsis of the surgical field Anesthesia Mount and dismount a scalpel blade Place an incision Incision technique Modalities for manipulating the scalpel Incision of an abscess Incision of a perianal abscess Incision of panaritia Incision of a carbuncle Incidents and accidents of incision

2. Drainage Stage / Criterion Correct Incorrect Check the identity of the patient undergoing incision and drainage, explain the procedure, and position the patient Materials required for drainage Asepsis of the surgical field Anesthesia Choice of the purpose and type of drain Place a drain Secure a drain Monitor a drain Remove a drain Incidents and accidents of drainage