Novel Technique Improved Skin Abscess Drainage

ACEP News
January 2009

By Patrice Wendling
Elsevier Global Medical News

CHICAGO - The LOOP incision and drainage technique significantly improved the failure rate of simple skin abscesses in a retrospective analysis of 233 children.

"The introduction of this innovative alternative technique for the treatment of simple skin abscesses may alter the way abscesses are treated in the future," principal investigator Dr. Jay G. Ladde and colleagues at the Orlando (Fla.) Regional Medical Center reported in a poster at the Research Forum of the American College of Emergency Physicians.

The treatment of simple skin abscesses hasn't varied significantly over the last several decades, with most emergency departments performing a traditional incision and drainage with packing placement.

In the LOOP technique, bipolar small incisions are made at the abscess borders. After adequate drainage, a loop drain is passed through the abscess pocket and secured at the surface by tying the loose ends. The loop drain is cut 7-10 days post op.

0109SkinAbscessThe technique was first used at the Orlando institution by pediatric surgeons, and its design was adapted for use in the emergency department by emergency physicians, Dr. Ladde said in an interview.

"The advantage the drain seems to offer is that it allows us to place it with as much effort as the standard incision and drainage with packing technique, but it will not fall out and is much easier to care for," he said. Because it is secured, patients can clean around it and bathe. With the standard technique, however, the packing often is cumbersome and falls out - leading to a second procedure.

The investigators reviewed the charts of 233 children (from birth to age 18 years) who presented with skin abscesses to the center's level I pediatric trauma emergency department from January 2007 to December 2007. Patients with abscesses on the face, scalp, hands, or feet, and those undergoing surgical debridement, were excluded.

The primary outcome was failure rate at follow-up within 10 days, as defined by requiring admission, IV antibiotics, or repeat drainage.

Assessment of outcome was possible in 52 of 79 patients (66%) treated with the LOOP technique, and in 91 of 154 patients (59%) treated with the standard incision and drainage with packing.

The failure rate was significantly lower in the LOOP group, at 1.4%, compared with 10.5% in the standard group, said Dr. Ladde.

Patients in the LOOP group were significantly younger (4.4 years) than in the standard group (7.1 years), and were significantly more likely to have received sedation (65% vs. 35%).

The LOOP group had significantly more abscesses than the standard group on the torso (9% vs. 7%), groin (12% vs. 9%), and buttock (42% vs. 23%), and significantly fewer on the upper extremity (9% vs. 14%) and lower extremity (25% vs. 38%).

A large prospective trial is underway to evaluate the LOOP technique in all populations, said Dr. Ladde, who disclosed no conflicts of interest.

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