Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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Abscesses and Other Infections Treated by Surgery Figure 13. Tenosynovitis and incisions to drain tenosynovitis. Figure 14. Tendon sheaths in the hand. 369 Figure 15. Sites of safe incisions in the palm. deep palmar abscesses should be located in the palm over the area of greatest tenderness when possible. Once the abscess is entered, insert a finger or forceps to determine the size of the abscess and where additional incisions may be made to provide adequate drainage. See Figure 15 for safe incision sites. 35
35 370 Surgery and Healing in the Developing World Figure 16. Unroofed ischiorectal abscess. Perianal/Perineal Superficial abscesses and boils are common in this region and require local drainage only. Recurrent boils may indicate an underlying condition such as diabetes mellitus. Deeper infections are potentially dangerous and must be diagnosed early and treated aggressively. Ischiorectal Abscess These abscesses occur in the deep fat of the ischiorectal space. The patient may give a history of pain on defecation followed by increasing pain and swelling, usually at one side of the anus. Tenderness becomes so severe that the patient is unable to sit comfortably and even walking is painful. Examination reveals a tender hot mass which may or may not be red. The above symptoms and signs are sufficient to indicate incision and drainage of the abscess. Fluctuance is a late sign and surgical drainage should not await fluctuance in this region. Drainage can be provided under local anesthesia, injecting 0.5% tetracaine liberally along the line of incision and widely in the fat over the abscess. However, general anesthesia provides more comfort for patient and surgeon in the exposure and drainage of all loculi and cavities. The surest approach is to do a wide incision unroofing the entire abscess. Removal of an ellipse of skin helps keep the cavity open (Fig. 16). The cavity is then packed loosely with a single piece of sterile gauze. (Insertion of more than one piece of gauze into a large abscess sometimes results a piece of gauze inadvertently being left in the wound.) The large gaping wound will take several weeks to heal but leave a surprisingly small scar. Some experienced surgeons may opt, in defined circumstances, for a smaller incision and insertion of a drain. This latter approach facilitates early discharge home and may avoid admission to hospital, but it may also lead to inadequate drainage and recurrence of the abscess. Intravenous antibiotics should be administered immediately prior to drainage to minimize the risks of bacteremia associated with the procedure. Cultures of the pus should not be affected by this. Choose antibiotics, such as chloromycetin or a combination of gentamicin and flagyl, to cover aerobic and anaerobic gut organisms. In every case, the patient should be advised that a fistula-in-ano may develop later. Perineal Abscess Perineal abscess may be a variant of ischiorectal abscess located anterior to the anus. It may also, in males, be due to trauma to the urethra or impacted urethral calculi. Gonnorrhea or tuberculosis may produce perineal abscesses. Drainage should be as for ischiorectal abscesses.
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Surgery and Healing in the Developi
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Contents Foreword .................
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25. Dentistry .....................
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Editor Contributors Harold P. Adolp
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Foreword Surgery and Healing in the
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“poor, but modern”, as for exam
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There may be at least one considera
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It is that higher accountability th
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1 2 Surgery and Healing in the Deve
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CHAPTER 2 Surgery in Developing Cou
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2 10 Surgery and Healing in the Dev
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CHAPTER 4 International Surgical Ed
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CHAPTER 9 Lab-in-a-Suitcase: Saving
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10 72 Surgery and Healing in the De
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CHAPTER 12 Communication in the Thi
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CHAPTER 13 Anesthesia in the Third
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13 100 Surgery and Healing in the D
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CHAPTER 15 Basic Obstetrics and Obs
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CHAPTER 16 Pointers for American Su
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CHAPTER 20 Chronic Pyogenic Osteomy
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CHAPTER 23 Cleft Lip and Palate Sur
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CHAPTER 24 Outreach Dentistry: A Wo
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CHAPTER 1 CHAPTER 26 Reconstructive
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Reconstructive Surgery in the Tropi
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CHAPTER 1 CHAPTER 27 Factors Influe
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Distribution and Incidence of Tropi
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CHAPTER 1 CHAPTER 28 Population Dyn
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Population Dynamics Of Surgical Tro
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Metabolic Maladaptation 289 Introdu
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Metabolic Maladaptation 291 some of
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Metabolic Maladaptation 293 In this
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Metabolic Maladaptation Table 1. Si
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Metabolic Maladaptation Table 4. Go
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Metabolic Maladaptation 299 the rev
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Metabolic Maladaptation Table 5. As
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Metabolic Maladaptation Table 6. Co
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Metabolic Maladaptation 305 the ris
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Metabolic Maladaptation Table 8. Go
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Metabolic Maladaptation Table 10. G
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Metabolic Maladaptation Table 12. C
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Metabolic Maladaptation 313 cell an
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Metabolic Maladaptation 315 Biologi
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Metabolic Maladaptation 317 from io
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Page 340 and 341: CHAPTER 1 CHAPTER 31 Uterine Ruptur
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Page 346 and 347: CHAPTER 1 CHAPTER 32 Vesicovaginal
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Page 350 and 351: CHAPTER 1 CHAPTER 33 Ophthalmology
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Page 420 and 421: Mobile Surgery Figure 1. 405 of tec
Page 422 and 423: Mobile Surgery Figure 3. 407 Childr
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Medical Adventures in the Nigerian
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CHAPTER 1 CHAPTER 42 Wanted Glenn G
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Wanted 431 Studies Center (//www.am
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Wanted 433 MacArthur (The John D. a
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Wanted 435 most pathologic presenta
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Wanted 437 “outliers” in the he
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World Health 439 challenge: name fo
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CHAPTER 1 CHAPTER 44 Treating Other
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Treating Others: Human Sciences in
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Treating Others: Human Sciences in
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CHAPTER 1 CHAPTER 45 The Impact of
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The Impact of a Volunteer Medical M
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CHAPTER 1 CHAPTER 46 Field Notes on
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Field Notes on a Typical Day in a H
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Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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