Incision and Drainage

Incision and Drainage
Incision and drainage (I&D) allows for decompression of infection loculation(s), which will provide significant relief for the patient. It will also provide a portal for irrigation and placement of a drain in some cases. Additionally, it allows for obtaining appropriate samples for culturing the offending microorganisms. More importantly, I&D will alter the chemical environment to one that is more aerobic, thus less optimal for the more virulent anaerobic bacteria.

In their 2011 article, Shanti and Aziz found no benefit in delaying the drainage of an infection until an abscess was formed. In fact, the majority of infections that were diagnosed as cellulitis were indeed abscesses. The delay in treatment will only lead to more complications and morbidity.

Typically, I&D is done at the same time as the removal of the offending source. However, there are times that due to the acuity of the infection, drainage is done first in conjunction with pharmacologic therapy while the definitive treatment is planned and carried out at a later time. This delay should be as minimal as possible as exacerbation of the infection will be likely.

The incision should be placed in such a way that it will avoid vital structures. It should also avoid any areas of mucosal or skin breakdown, such as a sinus tract as delayed healing or deformities may result.

Infections continue to challenge clinicians daily. Even though most remain focal and quite limited, when left untreated, they may have significant systemic involvement with potentially morbid, and possibly fatal, consequences.

Proper antibiotic selection has made combatting infections more predictable and improved patient outcomes. However, infection remains a surgical disease. Early, thorough, and definitive treatment directed at removal of the source and providing path of drainage will ensure proper care of the patient.