For patients who require drainage of the abscess under GA, it is important to be aware of the procedure they have undergone so that you understand how to manage them when they return to the ward.
It is important to remember that the main objectives of treating these patients is:
1) To secure the airway
2) Achieve drainage
3) Remove the source of the infection otherwise there will be a recollection
Generally whichever fascial spaces there are collections in, will be explored. This is why having a CT scan in these patients can be useful as it can guide where you need to make your incisions. Remember to always consider the underlying anatomy e.g. CN VII branches.
Returning to the ward
Once the operation has been completed, these patients will return to the ward with drains in-situ. There are many types of drains however in my experience, a corrugated drain is the most common one used, and they are sutured in place. The purpose of these drains is to keep the incision patent therefore allowing any pus which may remain to drain. Therefore they will also prevent any pus from recollecting.
The patient should also be written up for IV antibiotics. Intra-operatively, the surgeons will send a pus sample for MC&S. Therefore, you should be checking the micro results to ensure the correct antibiotics have been prescribed.
It’s important to be able to identify whether or not these patients are improving or perhaps may even be recollecting. As with most infections, you are looking to see a downwards trend in terms of WCC and CRP and an overall improvement in their observations. Patient’s themselves will let you know when they are feeling better.
If however, there is still a significant volume of pus being drained and a swelling redeveloping, raise this with a senior. Usually, the WCC and CRP will indicate persistent infection and in this case it is important to re-establish where the residual infection is. If a recollection of pus is suspected, your seniors may decide to request another CT scan.
In these cases, if the patient starts to deteriorate or the infection worsens, they may have to return to theatre for EUA, exploration and further debridement.
With regards to trismus, this can take some time to improve therefore its worthwhile demonstrating jaw opening exercises to these patients for them to practice at home once they have been discharged.
As the patient
is improving, the drains need to be removed. Note they are only removed once your seniors are happy that there is no remaining pus in the wound and there is no longer any drainage.
Patient should be sent home with oral antibiotics and ideally reviewed on an outpatient basis 5-7 days later.