Primary care
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An abscess is a localized collection of purulent material surrounded by inflammation and granulation in response to an infectious source. Most simple abscesses can be diagnosed upon clinical examination and safely be managed in the ambulatory office with incision and drainage. Wound culture and antibiotics do not improve healing, but packing wounds larger than 5 cm may reduce recurrence and complications.
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Primary care physicians provide a wide variety of treatments and conditions affecting the foot. This article discusses the removal of toenails, both full and partial removal. Subungual hematoma/Subungual blistering evacuation as well as wart, corn, callus, and blister management will also be discussed.
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Office-based laboratory and bedside diagnostic procedures can be a helpful tool when assessing patients in the ambulatory setting. Diagnostic tests using a microscope (including assessment of vaginal discharge, urinary sediment, or skin scraping) or a diagnostic ultraviolet (UV) light (when evaluating the cornea or skin) can add valuable information to aid in proper diagnosis. This chapter will review necessary materials, technique, and interpretation for these often simple and inexpensive evaluations.
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While Bartholin gland abscesses are less commonly seen outpatient pathology, prompt diagnosis and treatment are essential to preventing serious complications such as sepsis and rectovaginal fistula. Owing to an unacceptably high recurrence rate, simple incision and drainage is insufficient for primary treatment; preferably, placement of a Word catheter or Jacobi ring device to reepithelize the duct may be done under local anesthesia in an outpatient clinic. Destruction of the gland through silver nitrate application or alcohol sclerotherapy is an alternative. Marsupialization is often reserved for recurrent cases, although can be offered as primary management in some situations.