An urgent incision and drainage procedure is required when an acute pilonidal abscess has developed.
When an acute pilonidal abscess has developed, an urgent incision and drainage procedure is required. This is either performed in our Center under local anesthetic, or in an operative suite under mild intravenous sedation. The setting chosen is determined by the size of the abscess and patient preference. In this procedure, a small cruciate incision is created over the area of maximal fluctuance. The abscess cavity is entered with a fine hemostat, releasing the copious purulent fluid contained within. This fluid is sent to the laboratory for bacterial culture. Relief is immediate and dramatic. The cavity is packed with an iodinated strip and cleanly bandaged. The patient is sent home with an empiric oral antibiotic course and a light analgesic. The packing is self-removed in 48 hours, and the cavity is left open to heal from its depths outward.
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