Suppuration in a patient's axilla can take several forms: (1) Pus can form superficially in his apocrine glands. (2) It can form more deeply in the lymph nodes under his pectoralis major. Open deep abscesses promptly, because pus can track along his nerve trunks into his neck.
AXILLARY ABSCESSES For the general method, see Section 5.2. Abduct the patient's arm.
If his abscess is superficial (usual), incise over it.
If his abscess is deep (unusual), make a 3 to 5 cm incision just behind the fold of his pectoralis major, so as to avoid his axillary vessels. Push a haemostat upwards into the swelling, open its handles parallel to important structures, and open the abscess. Insert a drain.
If his whole axilla is a bag of pus, incise low in his axilla.
If he has a large subacute or chronic abscess, consider the possibility of tuberculosis, especially if the surrounding tissues are indurated, sinuses are present, and the breast is swollen from lymphoedema, perhaps with peau d'orange.
If he has multiple recurrent small abscesses in his skin, they may: (1) Be caused by tuberculosis, so biopsy one. Otherwise do a therapeutic trial with chemotherapy for tuberculosis. (2) Be caused by fungi. (3) Originate in sweat glands (HIRADENITIS SUPPURATIVA, unusual). Incision will not help much and may lead to keloid formation. If you suspect this try metronidazole and regular swabbing with a mild antiseptic, such as cetrimide.
Fig. 5-9 AN AXILLARY ABSCESS can form superficially in a patient's apocrine glands. Pus can also form more deeply in the lymph nodes under his pectoralis major. Open deep the abscesses promptly, because pus can track along his nerve trunks into his neck.