R gluteal abcess

Here are the photos of the upper outer R gluteal abcess secondary to self administered gym steroids in an 18 year-old male. Failed antibiotics given twice in local ER's prior to self referring to Medicos in Memphis.

Widespread necrosis had resulted, and the initial incision required debridement of substantial skin.

This left a large opening which had been infected for 10-14 days at the original time of incision at Medicos. Management by secondary intention with packing every 2-3 days has been ongoing for two weeks. Note lack of pus and infection despite no antibiotics. Infection resolved within 2 days of incision and drainage. Patient returned to work 2 days after incision and drainage.

But, continues to have transudative drainage secondary to normal process of granulation and cellular repair. Body is attempting to close the long axis of the oval,but at this point we will be improvising with tape to attempt some assist of closure  by natural forces; ie will use principles of steri-strips to achieve approximation of wound edges.

                                                                                                                                                             More to follow. 

                                                                                                

Wm MacMillan Rodney MD
Adjunct Professor of Family Medicine
Adjunct Professor Surgery/Emergency Medicine
Meharry/Vanderbilt School of Medicine

Medicos para la Familia
Memphis and Nashville, Tn.
www.psot.com

Abcess Case and Implications for Training

Original incision was 12 cm long. Patient is white bread , no risk, middle class, just graduated from high school. Review of systems negative for travel, exposure, night sweats. weight loss, appetite loss, n,v, fatigue, cough.

Generally, family medicine residencies are not preparing graduates to deal with wound care problems like these. This is particularly damaging to rural and other underserved communities where these cases are common.

For those who wrote with comments about me being a "surgeon", my appointment in surgery came as a result of my work in rural emergency medicine through the medical specialty of Family Medicine. Like many, I graduated from a mediocre FP residency, but had the good fortune of many terrific opportunities in community practice. These are the skills my faculty try to teach in our FAMILY MEDICINE-ER-OB fellowships.

Noting that photos could only be sent to individuals by request.

Rocco's abcess---Another example of minor surgical cases occurring regularly when services are provided open access to the community. After ten years, I’m still waiting to see the value of routine cultures on these cases.

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