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INCISION AND DRAINAGE PROCEDURES

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SUMMARY

  • I&D may be used to treat various conditions that require the release of enclosed contents, such as hematomas, furuncles, and infected cysts.

  • Placing the incision parallel to relaxed skin tension lines may mitigate the appearance of more prominent scars.

  • While these procedures are straightforward and can be performed with great rapidity, a poorly performed I&D procedure may serve only to exacerbate an already unpleasant or even dangerous condition.

image Beginner Tips

  • Choose the most fluctuant area of the lesion, which represents the most liquefied portion of exudate, for easy drainage.

  • Choosing the dependent area to facilitate drainage by gravity effect may also reduce the need for manual pressure and attendant patient discomfort.

  • Thicker exudate such as blood, coagulum, or mucin requires a longer time to start draining.

image Expert Tips

  • An 18G needle can be useful for I&D on very small lesions. Due to the small opening of this type of incision, thick exudate may not drain out easily. After stabbing, keep the tip of the 18G inside the lesion, push the needle tip laterally to widen the slit-like cut, and wait for exudate to drain.

  • Collect fresh, uncontaminated exudate for swab culture to improve the accuracy of culture and sensitivity; avoid collecting the skin surface–contaminated exudate. Allow the exudate to be collected to drain without running on the skin by compressing the lesion and holding the tip of the swab at the proper position and angle.

image Don’t Forget!

  • If no or minimal drainage occurs, assess the patency of the incision site.

  • Inject lidocaine in the superficial dermis, not into the lesional cavity. Pain with incision may occur when lidocaine injection occurs inside the lesion instead of the dermis and adjacent subcutaneous tissue. A ring block can also be considered.

image Pitfalls and Cautions

  • The incision should be stopped as soon as the clinician senses low tissue resistance, in order to avoid tissue damage at the base of lesion.

  • Bleeding at incision sites is common. Use external compression to control bleeding.

image Patient Education Points

  • I&D is a fast and effective procedure, but does not guarantee that a given fluid collection will not recur.

  • For inflamed or infected cysts, patients should be warned to expect recurrence, and definitive excisional surgery may be needed in the future.

  • I&D requires significant postoperative care, as wounds generally need to be packed or cared for in other ways. Patients should understand that postprocedure management is a process, and drainage may persist for longer than anticipated.

image Billing Pearls

  • I&D of an abscess is most frequently coded using CPT code 10060. When draining multiple abscesses, 10061 may be coded, and this code may be used for “complicated” lesions as well, though its use should clearly be justified in the body of the surgical report. Additionally, 10140 may be used for nonabscess I&D. The ...

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