Hilton’s Method of Incision and Drainage; The method of opening an abscess ensures that no blood vessel or nerve in the viscinity is damaged and is called Hilton’s method.
Steps of Hilton’s Method of Incision and Drainage
- Topical anesthesia: Topical anesthesia is achieved with the help of ethyl chloride spray.
- Stab incision: Made over a point of maximum fluctuation in the most dependent area along the skin creases, through skin and subcutaneous tissue.
- If pus is not found by the stab incision then further deepening of surgical site is achieved with sinus forceps (to avoid damage to vital structures).
- Closed forceps are inserted through the tough deep fascia and advanced towards the pus collection.
- Abscess cavity is entered and forceps opened in a direction parallel to vital structures.
- Pus flows along sides of the beaks.
- Explore the entire cavity for additional loculi.
- For Placement of drain a soft corrugated rubber drain is inserted into the depth of the abscess cavity; and external part of drainage is secured to the wound margin with the help of sutures.
- Drain left for at least 24 hours.
- Dressing: Dressing is always applied over the site of incision taken extraorally without pressure.
- Purpose of keeping the drain in such incision: The purpose of this drain is to allow the discharge of tissue fluids and pus from the wound by keeping the drainage tube patent. The drain allows for debridement of the abscess cavity by irrigation. Tissue fluids always flow with the external surface of a latex drain. So, it is not always required to make perforations in the drain, which may weaken and perhaps cause fragmentation within the tissues.
- Removal of drains: Drains should be removed when the drainage has nearly completely ceased. Drains have shown to allow ingress of skin flora along their surfaces. Some form of drains, such as latex drains in particular, are irritating to the surrounding tissues and may stimulate some exudates formation on their own. Thus, drains are usually left in infected wounds for 2 to 7 day.
Instruments used to drain an abscess
Lister’s Sinus Forceps
The instrument has long narrow blades which are serrated transversely for only half an inch at the tip. The instrument does not have a catch. The tip is rounded and bulbous. The shank and the tip are almost at equal length.
- To open an abscess by Hilton’s method, to break the loculae.
- To hold a small piece of gauze between the blades to clean a cavity.
- To dissect out sinus and fistulous tracts in soft tissues.
Hemostatic Forceps (Spencer Wells, Kelly’s, Halstead)
These forceps are better known as hemostatic forceps although they are used for catching both arteries and veins. They are used to catch hold of bleeding vessels. The unidirectional, transverse serrations on the blades of the hemostat mainly prevent the vessel from slipping. The vessel is crushed between the blades of forceps and hemostasis is achieved. The handle of hemostatic forceps has a catch and the vessel may be held and clamped. Small bleeders may be controlled by just crushing the vessel, whereas bigger vessels may be cauterized or ligated.
Types of Hemostats
A small curved artery forceps is called mosquito forceps.
- To achieve hemostasis by catching blood vessels. Hemostasis may be achieved just by crushing the vessels or by ligating or cauterizing them.
- To hold the ends of ligatures.
- As tissue forceps for holding subcutaneous tissues, aponeurosis (but not skin or nerves)
- To drain an abscess by Hilton’s method
- To pick up dead tissue, granulation tissue, foreign bodies, tooth/root pieces, small fragments of bone, etc.
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