Incision and Drainage Preparation of the site includes cleansing of the skin with antiseptic solution With a no 11 scalpel blade, incise the skin over the abscess parallel to the natural creases of the skin to the depth of the superficial fascia Then, bluntly open the abscess with a hemostat for at least cm, as shown in Figure 130.33C Insert the hemostat into the abscess cavity to break up any septae, remaining cognizant of potential underlying structures Obtain cultures of the purulent material if clinically indicated and express as much purulence from the cavity as possible The abscess cavity may be irrigated with normal saline to facilitate removal of debris Pack the wound lightly with a packing strip leaving to cm of the strip outside of the cavity This will function to physically keep the wound open to promote further drainage Dress the wound with an absorbent dressing, which will draw additional drainage away from the skin surface Remove the packing in to days The utility of antibiotics in addition to incision and drainage is unclear; some recommend antibiotic use when there is significant surrounding cellulitis or systemic symptoms such as fever Vessel Loop Method of Incision and Drainage Incision and loop drainage is a minimally invasive technique for abscess management in children using a silicone vessel loop, a small Penrose drain, or a sterile rubber band It has gained popularity over the past decade due to various advantages over the traditional I&D method: (1) no packing changes, (2) smaller incisions leading to better cosmetic results, (3) ongoing drainage while the loop is in place Using a no 11 scalpel, make a small incision (5 to 10 mm) at one edge of the fluid collection, preferably where it extends closest to the skin surface or where it is already draining Use a hemostat to probe the cavity and break up loculations without damaging adjacent or underlying structures Obtain cultures of the purulent material if clinically indicated and express as much purulence from the cavity as possible Use the hemostat to probe to the opposite edge of the cavity and tent the skin where the second incision will be made Use the no 11 blade to make another incision over the hemostat tip The two incisions should not be further than cm apart Larger abscesses may require placement of multiple loops Attach a plastic intravenous catheter to a syringe and irrigate the cavity to remove debris (Alternatively, this irrigation technique can be done once the loop drain is securely in place.) Insert the hemostat so that it enters one incision, tunnels through the cavity, and exits via the other incision Use this hemostat to grab the vessel loop and pull it through the cavity so that the loop replaces the hemostat in each incision site ( Fig 130.34A ) Tie the two ends of