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Incision and drainage
Incision and drainage
The incision can be made using one of three techniques: cold steel, punch biopsy, or carbon dioxide laser. All incisions should be made parallel to the relaxed skin tension lines. An elongated triangular surgical blade (#11) or a blade with a small curved edge (#15) should be used for the cold steel incision.19,20 The stab incision should be made directly over the peak of the abscess, taking care not to puncture the back wall. When performing a CO2 laser incision, the incision may be completed in the cutting mode or by vaporization in the ablative laser mode by repeated passing over the skin. Alternatively, the abscess can be opened with a 5- to 8-mm disposable biopsy punch to insure an aperture of sufficient size.17 The surrounding skin is stretched perpendicular to the skin tension lines so that the wound will form an oval.17 The biopsy punch is taken vertically down into the skin using a rotating motion until the abscess is reached. Subsequently, the abscess is allowed to drain spontaneously, pressure can be applied to
the surrounding tissue to further drain the contents.19,20 The cavity is irrigated using a saline solution until the draining solution is clear. An additional injection with triamcinolone can be given in the surrounding infiltrated skin.