Hilton method for abscess, incision and drainage (VIDEO)
An abscess is a confined collection of pus surrounded by inflamed tissue. Most abscesses are found on the extremities, buttocks, breast, axilla, groin, and areas prone to friction or minor trauma, but they may be found in any area of the body. Abscesses are formed when the skin is invaded by microorganisms. Cellulitis may precede or occur in conjunction with an abscess. The two most common microorganisms leading to abscess formation are Staphylococcus and Streptococcus. Perianal abscesses are commonly caused by enteric organisms. Gram-negative organisms and anaerobic bacteria also contribute to abscess formation.
Treatment of an abscess is primarily through incision and drainage (I&D). Smaller abscesses (<5 mm) may resolve spontaneously with the application of warm compresses and antibiotic therapy. Larger abscesses will require I&D as a result of an increase in collection of pus, inflammation, and formation of the abscess cavity, which lessens the success of conservative measures.
Untreated abscesses may follow one of two courses. The abscess may remain deep and slowly reabsorb, or the overlying epithelium may attenuate (i.e., pointing), allowing the abscess to spontaneously rupture to the surface and drain. Rarely, deep extension into the subcutaneous tissue may be followed by sloughing and extensive scarring. Conservative therapy for small abscesses includes warm, wet compresses and anti-Staphylococcal antibiotics. I&D is a time-honored method of draining abscesses to relieve pain and speed healing. Routine cultures and antibiotics are usually unnecessary if an abscess is properly drained.
During drainage of abscess situated in important areas like axilla, groin there is chance of injury to the underlying major vessels and nerves if adequate care is not taken. In drainage of abscess in such location the skin and the subcutaneous tissues arc incised with a knife. The dccp fascia is not incised with a sharp knife but is pierced by thrushing a sinus forceps through the deep fascia and the sinus forceps is then opened up to enlarge the open-ing in the deep fascia for easy drainage of pus. This is Hilton’s method of drainage of abscess.