Dr.Srivastava: In this video, we demonstrate
the technique of Ultrasound Guided Vacuum Suction Drainage
for Lactational Breast abscess.
Our patient is a 26-year-old
mother of a month old baby
presenting with a painful swollen left breast
and fever for one week.
She was unable to feed from the left side.
Examination revealed a febrile patient
with the markedly swollen red-hot
and tender left mammary gland.
The skin was edematous
with partial inversion of the left nipple.
An ultrasound examination revealed
a large inframammary breast abscess.
We carried out drainage of this abscess
with vacuum suction drainage.
The procedure was carried out
under sedation and Ketamine anesthesia.
An interoperable ultrasound localized the abscess
and an area was chosen where a skin was closest
to the abscess wall.
The skin was infiltrated with 2% lidocaine anesthesia
with the 23 gauge blue needle.
Needle was introduced deeper with suction maintained.
As soon as the abscess cavity was entered,
pus was obtained in the syringe.
We retained this syringe to serve
as a guide for insertion of the suction canula.
A small stab incision was made near this syringe
and an artery forcep introduced into the abscess cavity.
Entry of the artery forcep was marked with a gush of pus.
The artery forcep was moved around to break all septuor.
A 14 gauge suction canula was next introduced
into the cavity and retained in position with a silk suture.
We used a three-way system
to facilitate repeated suction
and irrigation with normal saline
till clear fluid was obtained.
5% Povidone-iodine solution was next instilled
into the cavity to kill any viable bacteria.
This povidone-iodine was next removed by further irrigation
with normal saline and suction apparatus was connected
after removing the three-way system.
The lady was treated with antibiotics.
The abscess cavity was irrigated once a day
with normal saline.
The post drainage diminished gradually till day seven,
when we observed milk in the drainage.
A microscopic examination of this milk
revealed absence of bacteria and pastels,
hence, the suction drain was removed on day nine.
There was no recurrence of abscess.
She was encouraged to breastfeed
from day one of suction tube in insertion.