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“I m dr. Mia cowan. Welcome back to ach wound center milwaukee wisconsin for another another edition of the wound care window. Very interesting patient like to share with you is a young lady with selex liked foot deformity that we were managing for an ulcerative process in this area here.
And she did very very well with aggressive offloading and in fact heal that a few weeks after healing. She developed an abscess in this area of the foot. And that was drained open and drained and would put her on a course of antibiotics and she was doing very well with near complete healing and then a few days ago. I started to develop another area over the dorsum foot and this is fluctuate.
It s tender it s warm and certainly infected. So we got an abscess here..
What s interesting about this case is you would think that we would have had some spread maybe in the subdermal plains. But probing this there is no tracking there s no undermining that goes from this wound to this area. So i m not exactly sure how we developed this infection here. When there was no evidence of this before but obviously.
There s something going on of a communication. So we re gonna go ahead and drain. This area again put her on some antibiotics. I thought i would share this procedure with you so if i could some betadine please so we ll prep.
The area with a little betadine as we ve talked in the past an ascetic in a setting like this is difficult to always provide the relief that we want because of the inflammation. We re gonna try to run this up you can see the wheel being raised and the blanching..
So that s actually gonna mount of an ascetic. There hopefully we ll get the desired effect. What pain relieves the end point. So we ll wait for the beaten and up a little alcohol.
We ve waited our three to five minute duration. How to allow the anesthetic to take effect to investigation possible as you can see we saw have a little bit of boozing. The vasoconstriction from the hawaikan is occurring slowly here. So some considerations for an ind you want to obviously go in the the skin folds.
And the folds run across the foot this way not up and down across as i made this incision. If you were to go this direction the skin folds would actually pull the wound open and we wouldn t certainly don t want that as part of the healing process..
So we re gonna go with the lot of the skin lines skin folds alright. I ll make our incision and there s appearance. Okay. I want to make that incision large enough to drain the entire abscess cavity and then as we ve talked in the past.
It s very important to decompress the entire area this is really a procedure. Where you can t be you can top up the entire foot for this and this is this is certainly tender for the patients. We want to milk that pus out to the greatest extent possible take the pickups and break up the lock. You lations inside the cab of the abscess cavity further evacuate that the greatest extent possible.
I was able to get into the entire abscess cavity. I ll go ahead and i ll pack this with some hypochlorous acid..
When you re packing. An abscess cavity. You really want to fill the cavity well you don t want this you want the cavity to drain. And so you have areas of the abscess that is not packed and will not decompress.
It well and we ll dress the foot and the patient will be starting on antibiotics and hopefully we ll heal this one just like she did the last one so i hope you ve enjoyed this edition of the wound care window. And another demonstration of abscess drainage you ” ..
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