Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Abscesses and Other Infections Treated by Surgery
Figure 2. Paratonsillar abscess (quinsy).
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therapy. The infection and swelling will gradually subside. If the nodes are large,
painful and fluctuant, drainage by a large-bore needle is helpful. Open drainage
should be avoided as it is not necessary and leads to secondary infection. If incision
is made for open drainage and typical caseating or thin opalescent fluid contents are
found, the fascia and skin should be closed after evacuation of the abscess contents
to prevent secondary infection. If secondary infection has already occurred, pack the
abscess open. If the tuberculous adenitis has already drained spontaneously, the sinus
tracts may be enlarged surgically to provide more efficient drainage since secondary
infection will have already occurred.
Boils
Boils on the head and neck are potentially more dangerous than elsewhere, especially
those located in the central part of the face because of possible deep infection
of the paranasal sinuses and pyogenic thrombosis of the saggital sinus. Boils are
treated by incision and drainage after local or topical anesthesia. For large or recurrent
boils, a cruciate incision is beneficial.
Carbuncles
A carbuncle is a local group of boils forming sinuses and gradual necrosis of
overlying skin. They are more common in people with diabetes mellitus and where
there is poor hygiene. Diabetes mellitus must be ruled out or treated urgently. Antibiotics,
usually penicillin, are indicated especially in diabetic patients. If the carbuncle
is enlarging or becomes fluctuant, incise and drain it under local anesthetic
removing any necrotic skin or subcutaneous detritus. A carbuncle on the face requires
urgent surgical debridement if it fails to respond quickly to penicillin because
of the risk of deep spread and possible cavernous sinus thrombosis.
Paratonsillar Abscess (Quinsy) (Fig. 2)
Since the discovery of penicillin, this entity has become much less where there is
ready access to medical care. However, in many parts of the world it remains a very
common problem. Diagnosis is made for a patient who complains of pain in the
throat and one side of the neck and has difficulty talking and swallowing if there is
a distinct swelling in the anterior or posterior fauces on the same side. Treatment for
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