Hilton's Method of Incision and Drainage of Abscess

Underlying blood vessels or nerves may be injured while draining the abscess. So, a technique known as Hilton's method of  Incision and drainage is followed to prevent the underlying nerves and blood vessels.

Steps for incision and drainage:
1. First, topical anesthesia is achieved with the help of Ethyl Chloride spray.
2. Then, a stab incision is given over a point of maximum fluctuation in the most dependent area along the skin creases, through the skin and subcutaneous tissue
3. If pus cannot be seen, the surgical site is further deepened with Lister's sinus forceps to avoid the damage to underlying vital structures (vessels and nerves)
Lister's Sinus  Forceps

4. Keeping the forceps closed, it is pushed through the tough deep fascia and advanced towards the pus collection.
5. The forceps is then opened in a direction parallel to the vital structures after entering the abscess cavity. The pus flows along the sides of the beaks. Exploration of the entire cavity should be done in search of additional loculi.
6. Drain Placement: A soft yeat's or corrugated rubber drain is inserted into the depth of the abscess cavity and the external part is secured to the wound margin with the help of sutures and is left for at least 24 hours and should be removed when the drainage has nearly completely ceased.

The purpose of the drain is to allow the discharge of tissue fluids and pus from the wound by keeping it patent. The drain allows for debridement of the abscess cavity by irrigation.

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