**20. Treatment of skin abscess**

Some small cysts degrade without treatment, up to the point of disposal. Warm compresses help to speed up the process. It referred to as the incision and drainage when there is a great pain, tenderness and swelling. It is not necessary to wait for volatility. Under sterile conditions, local anesthesia either lidocaine or freezing spray is given [105].

Patients suffering from abscesses intravenous anesthesia large and extremely painful and may benefit pain during the exchange. Often enough having one hole tip stripes to open the abscess. After draining the pus, you must examine the cavity or glove full finger scan sites. Optional normal saline irrigation with gauze used to reduce dead space cavity and prevents the formation of vaccines. Usually the valves are removed after 24–48 h. However, the recent data did not prove the effectiveness of routine irrigation or packing. High local temperature may precipitate inflammation decision [106].

Surgical intervention is the main therapeutic method in cases of fasciitis enterocolitis (A-III). However, many cases of inflammation of the fascia Grunt may begin to Kthab descendant, and if you have been identified fasciitis necrotizing early and treated aggressively, it avoids some patients distort surgical procedures. It must be based on the decision of an aggressive surgery to several considerations. First, there is no response to antibiotics after a reasonable experience is the most common indicator. You must be judged to respond to antibiotics by reducing fever and toxicity and lack of progress. Second, deep toxicity, fever, low blood pressure, or skin and soft tissue provided during antibiotic treatment is an indication for surgical intervention. Third, when the local wound necrosis appears in any skin with easy dissecting along the fascia using a blunt tool, you need to make an incision and a more complete discharge. Fourth, any soft tissue infection accompanied by gas in the injured tissue suggests the presence of tissue necrosis requires Tbarva surgically and/or anesthesia.

Most of the patients must come back with rheumatoid fasciitis Grunt to the operating room over the first 24–36 h after the anesthesia process, and then a day until the surgical team finds no further need debridement. Although separate pus is usually absent, these wounds can discharge abundant amounts of tissue fluid. Aggressive management of fluid is necessary assistant.

You must treat inflammation of the fascia Grunt and/or toxic shock conjugate caused by *Streptococcus* Group A syndrome of streptococci using penicillin and clindamycin (A-II). The rationale for clindamycin in laboratory studies that show both the suppression of toxins and modify the production of cytokines (i.e., TNF), and on animal studies showing the effectiveness of superior versus penicillin, and two studies Rsiditin demonstrating the greater effectiveness of clindamycin for β-antibiotics lactam [107, 108]. You must add penicillin due to increased resistance

to Group A *Streptococcus* conjugate of Macroledat, although it is in the United States, only 0.5% of the Group A drug resistance Almacrolad is also resistant to clindamycin.

Cannot be recommended for sure using of beta globulin (B-II) intravenously in the treatment of toxic shock syndrome conjugate *Streptococcus*. Although there is sufficient evidence on the role of toxins *Streptococcus* outside the cellular in shock, organ failure, and the destruction of tissue, containing different sets of IVIG variable amounts of neutralizing antibodies to some of these toxins, and lacked the final clinical data [107]. One of observational studies have shown better results in patients receiving IVIG, but these patients were more likely to undergo surgery and received more than historical control subjects clindamycin [108]. Showed a second study, was a double-blind trial, which placebo-controlled northern Europe, no improvement statistically significant in survival, and specifically for this section, any decrease in due time for the lack of further progress fasciitis necrosis (69 h for IVIG group, compared to 36 h for a placebo) [109]. The results of these studies provide some promise. However, the Committee believes that further studies on the effectiveness of IVIG is necessary before it can make a recommendation on the use of IVIG for the treatment of toxic shock syndrome conjugate *Streptococcus*.
