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Irrigation & Debridement and Incision & Drainage

What are some methods that can be used to treat bone infection, joint infection or an abscess?

A procedure called Irrigation & Debridement is one of several treatments that can be used to fight bone or joint infection. Typically an irrigation & debridement procedure is performed in the operating room. Another procedure called Incision & Drainage can be used to treat an abscess. It may be performed in a doctor’s office or in the operating room.

What is Irrigation & Debridement?

Irrigation is when a liquid solution is poured over an open wound to make it easier to visualize the wound as well as to help remove debris from deeper parts of the wound. Debridement is the removal of infected or diseased tissue to promote wound healing.

When is Irrigation & Debridement a good option?

Treatment of an infected joint or a bone infection (osteomyelitis) involves multiple steps. Depending on the severity, irrigation, debridement, and other surgical procedures may be necessary.

What happens during Irrigation & Debridement?

The patient is under general anesthesia during irrigation & debridement. Irrigation involves using a syringe, a pressure canister, or a sprayer to deliver a solution to the wound. The solution, which is typically normal saline, is delivered to flush debris out of the wound.

After irrigation, the medical staff are better able to visualize the wound. If the wound is severe, surgical debridement may be necessary in which surgical instruments are used to remove the targeted tissue. Depending on the wound, negative pressure wound therapy (wound VAC) may be used after the procedure to promote healing. Severe infections may require multiple return trips to the operating room to irrigate and debride the affected area.

How much time does it take to perform Irrigation & Debridement?

A typical surgical irrigation & debridement can range from an hour to several hours depending on the severity of the wound.

How long must patients stay in the hospital after Irrigation & Debridement?

Length of stay at the hospital after irrigation & debridement depends on several parameters, including recovery from anesthesia and surgery, the patient’s level of pain, and the results of the patient’s blood work. Typical length of stay is several days.

What are the benefits and risks of Irrigation & Debridement?

The main benefit of irrigation & debridement is treating the infected limb and preventing the infection from spreading to surrounding areas or the blood. All the risks that are typically associated with surgery and anesthesia are possible. Some of these risks are further spread of the infection, spread of infection by the blood stream (bacteremia or sepsis), recurrence of infection, loss of blood, pain, decreased mobility, and reaction to anesthesia.

What is Incision & Drainage?

Incision & drainage is a medical procedure that may be performed in a doctor’s office or in the operating room. The most common reason for incision & drainage is to treat an abscess, which is a collection of pus in tissues of the body. Incision refers to the cut made to reach the abscess. Drainage refers to the release of pus from the body. An abscess right under the skin can be mostly drained using this procedure.

When is Incision & Drainage a good option?

An abscess is the most common reason, especially when the abscess is just below the skin. Abscesses are typically caused by a bacterial infection, which may result in pain, swelling and fever.

What happens during an Incision & Drainage?

The area around the abscess is prepared by cleaning the area with a solution such as povidone-iodine. The next step is to inject a local anesthetic, such as lidocaine, around the abscess. Once the area has been sufficiently numbed, an incision can be made on the skin overlying the abscess. This will allow the pus to drain out and a sample of the pus to be obtained so that a bacterial culture can be grown. The culture will help determine the appropriate antibiotics. After sufficient drainage, the remaining abscess cavity may be probed to ensure that there are no pockets of pus remaining. Additionally, a syringe with sterile saline can be used to irrigate the abscess cavity.

Typically the abscess cavity is not closed with sutures and is left to heal and close on its own. Depending on the circumstances, the abscess cavity may need to be packed with gauze and then a gauze dressing is applied. For more extensive abscesses that are deeper in the body (for example, ones that involve bones or joints), the skin wound may be closed and plastic drain holes inserted to allow any residual infection to drain out. In cases where the wound must be left open, negative pressure wound therapy (wound VAC) may be used to help the wound heal.

How much time does it take to perform Incision & Drainage?

A typical incision & drainage usually takes several minutes to perform. Sometimes it may take up to an hour.

How long must patients stay in the hospital after an Incision & Drainage?

In most cases, incision & drainage of a skin abscess would not require a patient to stay in the hospital. For more extensive, deeper infections, a patient may need to be hospitalized after the procedure.

What are the benefits and risks of an Incision & Drainage?

The main benefit is the removal of the pus from the body, which will allow the body to heal while reducing symptoms such as pain, swelling and fever. Risks may include pain from the incision/ injection, bleeding, and spread of infection.