Skills - Basic Office Procedure SDL

I&D of Abscess

• Definitive treatment for soft tissue abscess, especially when antibiotics alone are not effective
• Indicated when collection of pus is present that is not resolving spontaneously
• Contraindicated when premature incision is done before localization of pus
• Equipment needed: No. 11 scalpel blade, hemostat, 25G needle, local anesthetic, alcohol/chlorhex, gauze, and dressing
• Technique: prep with alcohol/chlorhex, anesthetic field block around periphery, cut along Langerhan's lines when possible, express material, explore cavity with cotton applicator/hemostats, and pack with gauze (but not tightly)

Complications of I&D

• Recurrent infection
• Necrosis of skin
• MRSA
• Bleeding

Shave Bx

• Used to biopsy lesion (obtain tissue sample) to guide definitive treatment
• May be used to excise lesion for curative or cosmetic purposes
• Contraindicated if melanoma is suspected; punch bx is preferred instead
• Equipment needed: local anesthetic, single-edged razor or No. 15 scalpel, alcohol/chlorhex, hemostatic agents (Monsel's or aluminum chloride), and abx ointment and bandage
• Technique: prep area, anesthesia underneath lesion to elevate it, shave lesion with scalpel blade parallel to skin (or razor blade), apply pressure and topical solution to achieve hemostasis, and apply abx ointment and bandage
• Send out specimen for culture

Punch Bx

• Used for complete removal of small lesions

Cyst Removal

• Remove sac of fluid by drawing ellipses around bulk of cyst, cutting along ellipses line, and removing entire cyst with breaking sac

Nail Removal due to Ingrown Nail

• Saltwater soaks recommended prior to invasive procedure
• Technique: use iodine/antiseptic to toe and toe touching it, set foot up where it faces downward, use anesthetic lidocaine w/o epinephrine using a digital block numbing method (1mL at base of toe), wait 3-5min, place hemostat above and under nail bed, cut with scissors and rotate outward to remove portion of ingrown toenail, apply pressure for bleeding and bandage, and keep bandage on for 24 hours and change it