Continuing Education Activity Incision and drainage (I and D) is a widely used procedure in various care settings including emergency departments and outpatient clinics. It is the primary treatment for skin and soft tissue abscesses, with or without adjunctive antibiotic therapy. This activity reviews the incision and drainage procedure, risks and benefits. The role of an interprofessional team will be discussed. Describe interprofessional team contributions to the comprehensive management of patients with skin and soft tissue abscesses. Incision and drainage (I&D) is a widely used procedure in various care settings, including emergency departments and outpatient clinics. It is the primary treatment for skin and soft tissue abscesses, with or without adjunctive antibiotic therapy. This activity will focus specifically on its use in the management of cutaneous abscesses. Based on 2013 data from the CDC, cutaneous abscesses accounted for about 2% of all presentations to the emergency department. The same data reports that 0.9% of all patients who presented to the emergency department underwent incision and drainage. In the pediatric population, the incidence of skin and soft tissue infection (SSTI) has increased, and hospitalization due to SSTI doubled in the last 20 years.[1] As such, being well versed in I&D is essential for clinicians in both the adult and pediatric care settings. Anatomy and Physiology Cutaneous abscesses are localized collections of pus that occur within the dermis and subcutaneous space. They occur virtually anywhere on the body; however, common locations for an abscess to develop are the groin, buttocks, axillae, and extremities. In most cases, a cutaneous abscess can be diagnosed clinically on the basis of physical examination alone. The classic characteristics of an abscess are erythema, induration, tenderness to palpation, and fluctuance. Care must be taken to differentiate between cellulitis and abscess, as the treatment for cellulitis is antibiotic therapy without drainage. Typically an abscess will be fluctuant on exam, whereas this is not a feature of cellulitis. In cases of equivocal clinical findings, ultrasonography can be used to assess for the presence of an abscess, in addition to providing information on size and location. Studies have been done to compare the use of physical exam and ultrasonography in the detection of an abscess. A prospective study in the pediatric population revealed that in cases when abscesses could not be diagnosed clinically, bedside ultrasound had higher sensitivity and specificity than the exam alone.[2] In the same study, there was no difference in sensitivity and specificity between exam and ultrasound when the abscess was diagnosed clinically. In terms of differences in outcomes (i.e., treatment failure), there is a study that assessed treatment failure rates ten days after I&D.[3] Patients who were diagnosed by ultrasound in addition to physical exam had lower treatment failure rates ten days after I&D in comparison to patients who were evaluated by exam alone. This suggests that performing an ultrasound to evaluate for abscess improves treatment outcomes; this is, of course, reliant on the availability of experienced technicians and radiologists. Indications Most patients with an abscess should have incision and drainage performed, as antibiotic therapy alone is not sufficient for treatment. In cases of small fluid collections, conservative management with antibiotics, in addition to the manual expression of pus can be considered. Contraindications Possible contraindications to bedside incision and drainage include large and deep abscesses, the presence of a pulsatile mass at the site of infection, proximity to the vasculature and nervous structures, the presence of a foreign body, and particular locations of an abscess. Certain