This young man had a painful swelling on the forehead for two weeks and had been treated with a course of antibiotics for three days. This settled some of the surrounding erythema and swelling but the lump persisted. The General Practitioner stated that he would normally incise such a lesion but both he and the patient were concerned about the cosmetic aspect of the scar in such a prominent position.
When the urgent referral was made this young man’s father called. He was alarmed about possible costs as he felt it was being done at a hospital. He was however reassured when told that the proper financial consent would be given before undertaking any procedure. He was also reassured when told that most abscesses can be drained in the office without incurring the cost of hospitalisation.
The Surgeon agreed to see the patient urgently when the doctor rang because of the possibility of infected swellings around the face can lead to dire consequences if left untreated because of the risk of spread of infection to vital structures such as the brain e.g. thrombophlebitis.
When seen by the Surgeon it was felt that this was most likely to be an abscess. The patient denied any previous swelling. However the possibility of an infected sebaceous cyst was still considered.
When the patient claimed that he would like to have a small scar the Surgeon explained also that the incision could also be a transverse one in the skin crease or a vertical one. The swelling is in the area of the supratrochlear nerve, which supplies sensation to the scalp. Division of this can be an embarrassing complication of surgery. This has to be considered when undertaking surgery and the patient was told there were small risks of some problems there.
The patient was also given an informed consent form to read. He was also told that the wound may be either packed or sutured after the procedure depending on circumstances and findings.