Abscess A Better Way to Drain Abscesses: The Berlin Technique

Abscess A Better Way to Drain Abscesses: The Berlin Technique

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Treatment Abscess

Abscesses can be treated in a number of different ways, depending on the type of abscess and how large it is.

The main treatment options include:

  • antibiotics  
  • a drainage procedure
  • surgery

Skin abscesses

Some small skin abscesses may drain naturally and get better without the need for treatment. Applying heat in the form of a warm compress, such as a warm flannel, may help reduce any swelling and speed up healing.

However, the flannel should be thoroughly washed afterwards and not used by other people, to avoid spreading the infection.

For larger or persistent skin abscesses, your GP may prescribe a course of antibiotics to help clear the infection and prevent it from spreading.

Sometimes, especially with recurrent infections, you may need to wash off all the bacteria from your body to prevent re-infection (decolonisation). This can be done using antiseptic soap for most of your body and an antibiotic cream for the inside of your nose.

However, antibiotics alone may not be enough to clear a skin abscess, and the pus may need to be drained to clear the infection. If a skin abscess isn’t drained, it may continue to grow and fill with pus until it bursts, which can be very painful and can cause the infection to spread or recur.

Incision and drainage

If your skin abscess needs draining, you’ll probably have a small operation carried out under anaesthetic  – usually a  local anaesthetic , where you remain awake and the area around the abscess is numbed.

During the procedure, the surgeon makes a cut (incision) in the abscess, to allow the pus to drain out. They may also take a sample of pus for testing.

Once all of the pus has been removed, the surgeon will clean the hole that is left by the abscess using sterile saline (a salt solution).

The abscess will be left open but covered with a wound dressing, so if any more pus is produced it can drain away easily. If the abscess is deep, an antiseptic dressing (gauze wick) may be placed inside the wound to keep it open.

The procedure may leave a small scar.

Internal abscesses

The pus usually needs to be drained from an internal abscess, either by using a needle inserted through the skin (percutaneous abscess drainage) or with surgery.

The method used will depend on the size of your abscess and where it is in your body.

Antibiotics will usually be given at the same time, to help kill the infection and prevent it spreading. These may be given as tablets or directly into a vein (intravenously). 

Percutaneous drainage

If the internal abscess is small, your surgeon may be able to drain it using a fine needle. Depending on the location of the abscess, this may be carried out using either a local or general anaesthetic .

The surgeon may use  ultrasound scans or computerised tomography (CT) scans to help guide the needle into the right place.

Once the abscess has been located, the surgeon drains the pus using the needle. They may make a small incision in your skin over the abscess, then insert a thin plastic tube called a drainage catheter into it.

The catheter allows the pus to drain out into a bag and may have to be left in place for up to a week.

This procedure may be carried out as a day case procedure, which means you’ll be able to go home the same day, although some people will need to stay in hospital for a few days.

As with the incision and drainage procedure for skin abscesses, percutaneous drainage may leave a small scar.

Surgery

You may need to undergo surgery if:

  • your internal abscess is too large to be drained with a needle
  • a needle can’t get to the abscess safely
  • needle drainage hasn’t been effective in removing all of the pus

The type of surgery you have will depend on the type of internal abscess you have and where it is in your body. Generally, it involves making a larger incision in your skin to allow the pus to be washed out.

Page last reviewed: 19/07/2016
Next review due: 19/07/2019

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How to Drain an Abscess or Boil



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Skin Health



More Skin Conditions

How to Drain an Abscess or Boil

Tips for Preventing Infection and Complications


By Naveed Saleh, MD, MS | Reviewed by Casey Gallagher, MD
Updated October 07, 2018
Close up of a boil

SCIENCE PHOTO LIBRARY / Getty Images
Skin Health

More in Skin Health


  • More Skin Conditions

    • Acne

    • Psoriasis

    • Eczema & Dermatitis

    • Fungal, Bacterial & Viral Infections

    • Skin Care & Cleansing Products

    At some point in your life, most people will have experienced a condition called a boil (also known as an abscess or furuncle). Draining these painful skin infections can be tricky and is typically best left to a medical professional.

    This is especially true if the boil is on the face, neck, hands, ankles, genitals, rectum , or any vulnerable area of skin as it would likely need to be drained by a specialist in an operating room. The same would apply if you have diabetes or have a compromised immune system.

    Preparing to Drain a Boil

    Superficial boils that affect fleshy parts of the skin — think the upper leg or torso — are more routinely drained as an in-office procedure. However, even some of these require surgical care if they are large or especially deep.

    An abscess must be drained in a sterile environment using sterile instruments which include, among other things, gloves, a mounted surgical blade, an irrigating syringe, sterile saline, and dressing.

    Anesthesia can be challenging when draining a boil. Injecting lidocaine in and around the painful mass can make the pain worse and risk puncturing the pus-filled abscess (particularly if it’s a carbuncle, a consolidated cluster of multiple boils).

    Smaller boils may benefit from an ethyl chloride spray which can numb the area of skin around the boil.

    How a Boil Is Drained in 5 Easy Steps

    As an in-office procedure, every effort is made to ensure a sterile environment. The procedure only takes around five to 10 minutes in total and most typically involves the following steps:

    1. The doctor dons the appropriate protective clothing and sterile gloves. A plastic absorbent pad is placed under the area to be drained.
    2. The doctor finds the point of maximal fluctuance or “bubbliness” (the head or point of the boil). Ethyl chloride may be used at this stage to numb the area.
    3. He makes a quick nick where the abscess is most fluctuant to release the pus. A sample of pus may be collected and sent to the lab for culturing.
    4. Depending on the size of the boil, the doctor may need to make subsequent incisions to ensure that little pockets (or loculations) of pus are completely drained.
    5. The cavity is irrigated with sterile saline, packed with gauze, dressed, and bandaged.

    After the boil is drained, your physician should prescribe a course of antibiotics. Because community-acquired MRSA (methicillin-resistance Staphylococcus aureus) is a common cause of skin and soft-tissue infections, Bactrim (TMP-SMX) is considered the best choice of treatment.

    It is important that you complete the course of antibiotics as directed to avoid the development of antibiotic drug resistance. Ideally, a follow-up appointment with your primary care physician should be made in the next few days.

    A Word From Verywell

    Despite warnings, people will often opt to lance a boil themselves. It might certainly seem to make sense if it is pimple-sized and not inordinately painful. The problem is that the unexpected can and does happen, and a “superficial” boil can turn out to be deeper and more extensive than imagined.

    Avoid the temptation. Instead, place a warm, wet cloth on the boil for 20 to 30 minute for four to five times per day. You can cover it with a heating pad to provide additional warmth. In about a week or maybe less, the boil may open on its own.

    When it does, wash the affected area with soap and water and dress with a sterile bandage. You can also use an over-the-counter antiseptic preparation like Bacitracin, Neosporin, or Betadine if the wound is small. Keep using heat for the next few days to promote draining, washing the area twice daily and applying a fresh bandage every time.

    If the boil fails to open on its own, don’t get frustrated and try to “pop” it. Squeezing only forces the infection deeper into your skin. Make an appointment to have it drained in a sterile environment.

    If you have a boil and experience any complications, including fever or a worsening of symptoms, see your doctor immediately or visit your nearest emergency room.

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    Article Sources





    • Partin, W, and Dorroh, C. “Chapter 7. Emergency Procedures.” CURRENT Diagnosis & Treatment Emergency Medicine, 7th ed. In: Stone C, Humphries RL. eds. New York, NY: McGraw-Hill; 2011.


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