Hilton’s Method of Incision and Drainage

Overview – Hilton’s Method of incision and drainage

Hilton’s method of abscess drainage is a method of incision and drainage to drain out abscesses that are placed around the areas having major nerves such as neck, groin and axilla. It is usually performed under general, regional or local anaesthesia. Different types of abscess are neck abscess, axillary abscess, parotid abscess, breast abscess, acute paronychia and anorectal abscess. Various complications related to drainage of abscess are damage to vital structures, bleeding from abscess cavity and sinus formation. Therefore, the incision for the drainage should be given on the most fluctuant part of the abscess so that spontaneous drainage of the pus can occur and prevent its accumulation in the abscess cavity.

Abscesses are a concern that can arise in any part of the body, but usually occur around the skin. They occur when the skin gets compromised or punctured and some foreign material or bacteria/virus gets touched to the soft tissue below the skin. When this happens, an inflammatory response acts like guard and is set off as the defence mechanism of the body to try and kill those foreign viruses or bacteria. Thus, in Hilton’s method of drainage an abscess is a collection of pus in a cavity formed by disintegrating tissue and surrounded by inflamed tissue. Abscess is understood as Vidradhi in Ayurvedic classics, which is classified into 2 varieties as Bahya and Abhyantara. In this work we are dealing with Bahya Vidradhi for the appraisal of incision and drainage.

Steps – Hilton’s method of drainage an abscess

A surgeon must be crystal clear in his concept to identify the indicated abscess appropriate for the drainage. Inadequate knowledge and poor planning give birth to mistakes and medical error. He must be able to differentiate the non-supportive stage with the supportive stage of the abscess. The shortcoming in selecting the case or the diagnosis of the clinical entity is sure to complicate the condition. So proper selection is must and proper timing for drainage should be identified. If the technique is performed on unaccommodating state, then it will not yield good clinical outcome.

When it comes to the steps of Hilton’s Method of Incision and Drainage

In the Hilton’s method of abscess drainage, a small opening is made around the abscess area using a closed blunt hemostat or sinus forceps. When the abscess opening is made open using the jaws of the sinus forceps or hemostat, it allows the purulent material to escape, which is precisely what happens in Hilton’s method.

When there is an abscess of larger size, the index finger is usually inserted through the made opening into the abscess opening, and the pus is set free carefully, which is palpating for deep pockets if any. But while this insertion of the finger happens, it is made sure that the finger does not open or broaden the normal tissue space.

Once all the purulent material like puss and water are evacuated, the made cavity is then cleared with usual saline using a bulb syringe. When comes the time of where the cavity could be sealed using a saline gauze and a part of it hangs out of the opening and wound. A corrugated rubber drain is used when there is a deeper pocket. 

When it comes to dressing the wound, saline gauze, gamji pads and bandages, or adhesive tapes are the best mode of treatment. 

An abscess is usually dressed once a day at least and goes up to as often as required if and when it gets loaded with purulent drainages and puss. When it comes to a new dressing, each dressing is further cleaned using saline if the pockets are more profound. 

There is continuous use of local application of betadine, antibiotics, chlorhexidine. If the cavity does not seem to get better with the above mentioned, abscesses and openings are then drained and dressed with saline gauze. 

Dressings can be facilitated particularly in the extremities utilising warm saline soaks in clean bowls. Elevation of the extremities involved, above the level of the heart adds to the comfort of the patient and helps in early healing.

In short, there is a total of 10 steps used in Hilton’s Method of drainage and incision. 

These are as follows.

1. Topical anaesthesia 

It is achieved with the help of ethyl chloride spray to make the area numb so that an opening can be made. 

2. Stab incision 

It is usually made over a point of maximum fluctuation around the most dependent area, which is along the skin creases, across the skin and the subcutaneous tissue.

3. In a situation when any pus or foreign material is not encountered, the surgical site is further deepened using sinus forceps in order to avoid damage to any vital bodily structure. 

4. Post this, closed forceps are inserted through the deep fascia and are pushed further towards the pus collection area.

5. Now, the abscess cavity is reached and entered, and now the forceps is forced open towards the direction parallel to the vital structure.

6. This allows the pus and other foreign material to flow along the sides of the instrument. 

7. The doctor then explores the made cavity for any additionally formed loculi.

8. Placement of a drain 

later a very soft corrugated rubber or yeat’s drain is penetrated into the very depth of the created abscess cavity, and later the external parts are secured to the margin of the main wound using a medicated suture

9. the drain is then left as is for at least 24 hours.

10. Dressing 

Once everything goes as planned, dressing is applied over the site of the incision taken externally without applying pressure.

Aftercare

After the Hilton’s method of incision and drainage, it is best to have bed rest, oral analgesia, and a prescribed night sedative after the method is complete. 

It is always said to have an administration of the dosage of antibiotic given to the patient post the method and should be continued for five days in oral form. 

If there is a breast abscess done, then some decision must be taken regarding the weaning process. It is usually fine to continue breastfeeding using the opposite breast or to manually extract milk from the operated side for the baby. 

Always plan on seeing the patient after 48 hours of drainage just to remove the pack and inspect the cavity. 

If the cavity is clean, only a dry dressing must be applied.

If there is any reactionary haemorrhage, admission to the hospital is advisable. The cavity must be re-explored under general anaesthesia, and the possible bleeding points should be secured using diathermy or under-running sutures. 

It usually takes around two to three weeks for a moderate-sized cavity to fill up and epithelialize. 

In case of an ischiorectal abscess or perianal, sitz baths are convenient. Use a sterilised sanitary pad for proper dressing. Avoid using any local antibiotics applications as it enhances the growth of resistant flora and occasionally results in intractable allergic dermatitis. Follow up treatment of a primary pathology such as fistula in urethral stricture and pilonidal sinus is necessary.

Instruments used in process

Entry point and seepage, and clinical spearing are minor surgeries to deliver discharge or strain developed under the skin, for example, from a canker, bubble, or tainted paranasal sinus. It is performed by treating the region with a disinfectant, for example, an iodine-based arrangement, and afterwards making a little cut to penetrate the skin utilising a sterile instrument like a sharp needle, a sharp surgical blade or a lancet. This permits the discharge liquid to escape by depleting out through the entry point. 

Good medical practice for large abdominal abscesses requires insertion of a drainage tube, preceded by insertion of a PICC line to enable treatment readiness for possible septic shock. Medical professionals often abbreviate incision and drainage as “I&D” or “IND”.

Lister’s Sinus Forceps is the instrument used. It has been named after British Surgeon Joseph Lister. This forceps has a very long straight blade along with ring handles, but it is without a ratchet lock. Usually, the tip of the blades is blunt and has transverse serrations. There is no catch that protects the viable tissue if the tissue accidentally comes in between the blades of the forceps.

The forceps have been designed to manipulate the sinus, fistula or abscess. It may be possibly used to use gauze plugs or introduce gauze or drain plugs in the nose and ear. The serrations ensure a firm grip while one is holding foreign bodies or removing granulation tissue from the sinus or fistula.

It is of stainless steel type 420, which has a place with class martensite according to ASTM Standards. The instrument is generally used to augment the lot during Incision and Drainage of the boil through Hilton’s Method in the crotch, axilla, neck or some other piece of the body. During Drainage of the sinus, the lister is acquainted with investigating the sinus prior to putting the channel. Further, it very well might be utilised to extricate unfamiliar bodies or add meds in the sinus and fistula. It is additionally used to present ridged elastic channels (CRD) to deplete the dead space in activities like extraction of lipoma or pimples.

Entry point and waste is a difficult method that, notwithstanding nearby sedatives, may likewise require oral or even parenteral absence of pain.

Results

Hilton’s method of abscess drainage the affected area becomes clear of any types of foreign substance and puss making the area in the perfect condition to function well. 

References 

1. MED India – Medical Education- Incision and Drainage of abscess – https://www.medindia.net/education/familymedicine/incision-drainage-abscess-incision.htm#:~:text=An%20opening%20is%20made%20into,to%20escape%20(Hilton’s%20method). 
2. PlexusMD- Steps in Hilton Method – https://www.plexusmd.com/md/post/hilton%E2%80%99s-method-of-incision-and/21925 
3. US National Library of Medicine National Institutes of Health – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2068446/ 
4. The BMJ- Book Review – https://www.bmj.com/content/1/4704/459.1 
5. Jaypee Digital – https://www.jaypeedigital.com/book/9789352703678/chapter/ch21 

Researchgate – SUSHRUTA’S METHOD NOT HILTON’S METHOD – https://www.researchgate.net/publication/321472716_SUSHRUTA’S_METHOD_NOT_HILTON’S_METHOD

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