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INCISION
INCISION
For smaller lesions, a #11 surgical blade is used to incise the selected and anesthetized area. It is commonly used for I&D due to its sharply pointed tip which is well suited for a perpendicular stabbing approach into the lesion, though if unavailable any blade, such as a #15 scalpel blade, will suffice. Following the initial stab to enter the cavity, the incision is extended to create an opening large enough for drainage, which is dependent on the consistency of exudate, and to prevent recurrence of lesion (recollection). For lesions of larger size and in certain locations (e.g., deeper set lesions on the back), a #15 or #10 surgical blade may be utilized preferentially.
Placing the incision parallel to relaxed skin tension lines may mitigate the appearance of more prominent scars. Care should be taken that the incision length not to be too short, restricting the ability of exudate to adequately drain, though an unnecessarily long incision will yield a more prominent scar. Err on the side of creating a shorter incision, as this can always be enlarged if needed.
Care should be taken not to overextend the depth of initial puncture incision, as accidentally stabbing through the base of the lesionโs cavity may sever underlying tissue or vessels, increasing the risk of persistent infection or bleeding.2 Stab incision depth should be designed only to permit the tip of surgical blade to pass through the skin and the wall of lesion; generally, once this is accomplished, there will be an immediate drop in tissue resistance, and often some of the material to be drained will appear.
Sterile cotton-tipped applicators may be inserted to gently probe the cavity down to its base and facilitate the removal of any remaining loculated or congealed fluid. Special care should be taken in making the incision if there are prominent vessels or nerves in the area, or when working close to anatomic danger zones. When incision is performed on highly vascularized area, such as a mucocele on mucosal lip, consider having an assistant apply steady pressure around the lesion while performing I&D for bleeding control and improve visualization. Care should be taken when incising highpressure lesions, as the contents may escape explosively in a projectile manner, contaminating the surgeon and surrounding area.