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Subject: Bartholin Gland Cyst and Abscess Treatment
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Prep solution (see Appendix E)
18- or 20-gauge needle and 5-mL syringe plus water or gel for inflation of catheter tip
No. 11 scalpel
Hemostat (for breaking up loculations)
Culture media for gonorrhea, chlamydia, and routine cultures
Silver nitrate sticks
Delayed-absorbable suture (3-0 or 4-0) on small cutting needle
Small needle driver
Enlarged or painful Bartholin cyst or abscess
Surgery on an acutely, severely inflamed abscess (relative contraindication)
Asymptomatic cysts (relative contraindication)
Latex allergy (e.g., to Word catheter)
PITFALL: Inject under and around the abscess, not into it. Lidocaine injected into the cavity is trapped and cannot provide anesthesia. Injection into the abscess can cause increased internal pressure and outward rupture of the abscess.
Pearl: It may cause less pain to simply incise without anesthesia an abscess that has very attenuated overlying skin.
PITFALL: Do not make the incision on the outer labium minus or labium majus. The resulting scar may cause pain, a poor cosmetic result, or a permanent fistula.
PITFALL: Do not extend the incision beyond the width of the blade, or the catheter will require a retention stitch.
PITFALL: Use water or gel rather than air to prevent premature deflation of the balloon.
PITFALL: The catheter frequently falls out. Placement of a vaginal suture into vulvar skin and tied to the catheter can help hold those that recurrently fall out.
PITFALL: If bleeding occurs, use suture placement or direct pressure for hemostasis of the skin edge.
Septic shock (with incision of abscess)
A standard office surgical tray used for simple surgical procedures is described in Appendix G.
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Word catheters may be ordered from Milex Products, Inc., Chicago, 11 (phone: 1-800-621-1278; http://www.milexproducts.com) or from your local Milex dealer.