Definition & Overview
Incision and drainage is a minor surgical procedure for removing fluid buildup from under the skin or infected sinus. It is commonly performed to treat several types of hematomas, seromas, and other soft tissue infections that lead to fluid accumulation. This procedure is also referred to as IND or I&D.
Incision and drainage is performed to release the pressure caused by the production of excess fluid, one of the body’s immune response to infection. I&D is often concurrent with antibiotics therapy, especially if the risk of developing bacterial infection following the procedure is high.
Who Should Undergo and Expected Results
The procedure can be recommended in cases of:
Hematoma - Patients suffering from hematoma are offered incision and drainage to relieve pressure caused by the collection of blood leaking out into the soft tissues of the body. This happens when the blood vessel walls were weakened due to disease or trauma. The flow of blood outside the veins, arteries, or capillaries can cause the surrounding tissue to develop an inflammatory response, with pain and swelling. Hematoma can also occur after surgery, especially among those sensitive to the effects of blood thinners.
Seroma - Undergoing cosmetic surgery can cause a buildup of fluid under the surface the skin. This condition is termed seroma and occurs at the surgical site, weeks after the surgery itself. It is considered as one of the body’s responses to tissue removal and typically affects people who had breast augmentation, tummy tuck, or liposuction in the arms, breast, thighs, and buttocks.
Skin abscess - Those who suffer from skin abscess like carbuncles are also advised to undergo the procedure. A carbuncle is a cluster or group of boils usually caused by bacterial infection. It is a type of skin abscess that drains pus under the skin. Any part of the body that has abnormal accumulation of fluid would be considered appropriate for this procedure.
Patients usually achieve immediate relief from pain and discomfort following incision and drainage. This procedure is considered safe with high success rate. Patients are advised to rest following the procedure and to keep the affected area elevated as much as possible. Bandages and dressings should be kept clean and must be regularly replaced to avoid infection.
Samples of the drained fluid may be sent to a pathology lab for further evaluation.
How is the Procedure Performed?
Depending on the need, the patient may be administered with general or local anaesthesia. The surgeon then makes a skin incision at the most prominent part of the hematoma or seroma. The skin is punctured using a sharp needle, a lancet, or a scalpel. The depth of the incision is dependent on the presence of blood vessels and nerves in the surgical site. A pair of sinus forceps is then inserted into the incision and the opening is gradually widened. The accumulated fluid is then drained. A small drainage tube may also be inserted and left inside the incision for several days to make sure that the affected area is completely fluid-free. The incision is then closed with absorbable sutures.
Possible Risks and Complications
- Pain and discomfort
- Bleeding at the surgical site
- Damage to nearby organs
Mortele KJ, Girshman J, Szejnfeld D, et al. CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. AJR Am J Roentgenol. 2009 Jan. 192(1):110-6.
Yamakado K, Takaki H, Nakatsuka A, et al. Percutaneous transhepatic drainage of inaccessible abdominal abscesses following abdominal surgery under real-time CT-fluoroscopic guidance. Cardiovasc Intervent Radiol. 2010 Feb. 33(1):161-3.