Definition & Overview
Post-surgical wounds that have been infected can be treated with incision and drainage.
Infection is one of the common risks faced by all patients who undergo a surgical procedure that requires an incision, or a break in the protective barrier of the skin, which makes contamination from exogenous or endogenous bacteria possible. This is why the majority of surgery patients are given antibacterial medications and post-operative wound care instructions.
When left untreated, post-operative wound infections can become complex and may lead to other, more serious complications, such as sepsis or even death if it spreads through the blood. Fortunately, this can be prevented through a proper incision and drainage procedure.
Who Should Undergo and Expected Results
Patients with post-operative wound infections or surgical site infection (SSI) are commonly subjected to incision and drainage.
SSI makes up around 20% of all infections that arise from health care services, and is the most common post-operative complication that arises from incisions along with wound dehiscence and post-operative blistering. A 2008 study showed that at least 5% of all surgery patients develop an SSI.
Some post-operative wound infections are simple or limited, but some of them are complex. Complex infections can have a major impact on the quality of a patient’s life, and can even lead to a high risk of morbidity and mortality. They can also cause extended hospital confinement and higher healthcare costs.
Serious infections can cause the following symptoms:
- Excessive inflammation
- Specific pain in wound
- Wound separation
- Excessive exudate
- Strikethrough or leakage
- Periwound skin stripping
- Collection of pus or yellow, green, or cloudy drainage seeping from the surgical wound
- Redness that is spiderweb-like or thread-like in appearance
- Raised skins
An incision and drainage procedure is used primarily to release causative organism that has led to the infection as well as the contaminated tissue, including the pus. Once the pus has been released and the wound has been thoroughly cleansed, the skin’s healing process can begin.
How is the Procedure Performed?
The incision and drainage of complex, post-operative wound infections is performed as a minor surgical procedure. It begins with the application of a local antiseptic, such as an iodine-based solution. The surgeon then makes a small incision using a sharp sterile needle or scalpel to puncture the skin to drain out the pus or infected fluid.
For large complex infections, such as abscesses, especially those in the abdominal region, the surgeon may also insert a drainage tube to prevent sepsis. Once the fluid has been drained out, the area is covered with a thin layer of gauze and sterile dressing.
After the procedure, the patient will be instructed to clean the wound with a saline solution and to change the sterile dressing at least twice a day. In most cases, the surgeon will also give the patient an antibiotic to prevent recurrent infections as the wound heals.
For big wounds, the edges of the incision may need to be re-closed with staples or sutures. The entire procedure may take 30 to 45 minutes.
Possible Risks and Complications
An incision and drainage of complex, post-operative wound infections places the patient at risk of:
- Allergic reactions to anaesthesia
Patients who are smokers or have diabetes may also experience delayed healing of the wound.
Milne J, Vowden P, Fumarola S, Leaper D. “Post-operative incision management.” Wounds UK. http://www.wounds-uk.com/made-easy/postoperative-incision-management
Jones GA, Butler J, Lieberman I, Schlenk R. “Negative-pressure wound therapy in the treatment of complex post-operative spinal wound infections: complications and lessons learned using vacuum-assisted closure.” J Neurosurg Spine. 2007 May;6(5):407-11. http://www.ncbi.nlm.nih.gov/pubmed/17542505