The Missing Gauze
It seems like as the years pass, I am seeing more and more abscesses in the ER. Hardly a night goes by that I don't incise and drain at least a couple of boils, and occasionally I'll see a couple more "wound checks" of abscesses previously drained by another doc. More often than not, these abscesses will have been packed with iodoform gauze. Just pull the string, pat the patient on the back, and move along.
Not this time. The gentleman in room 5 has already removed his dressing to reveal a one cm incision without any gauze sticking out of it.
"Looks pretty good," I said, thinking this patient would be even quicker than the typical wound check. Not so.
"I can't find the packing," he said. "I think it's inside there somewhere. I checked the bandage, the floor, everywhere." At home, of course, where he had removed the dressing.
I looked closer at the wound, gave it a little squeeze. No pus, just some blood tinged oozy stuff. Definitely no sign of any gauze. I wondered aloud how much gauze the other doc had packed it with.
"It seemed like a lot," said my new patient.
Hmmmmm, thought I...no way in heck is there any gauze in that wound. With a teeniny little incision like that, the gauze is much more likely to have come out than worked it's way inside...but I can't just not check.
"I'll have to numb you up a bit so I can look around in there." So I give him a local, I gently spread apart the edges....nothing. I scooped across with forceps....nope. Irrigated a bit, then dissected gently, then probed some more, finally extended the incision, looked harder, probed deeper....nothing. It just wasn't there. But maybe it was, how could I be sure?
So I told him to come back to see the guy who packed it originally, since only he knows for sure how much gauze he packed the wound with.