Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children

• Published in: Journal of pediatric surgery 2010-03, Vol.45 (3), p.606-609
• Main Authors: Tsoraides, Steven S, Pearl, Richard H, Stanfill, Amy B, Wallace, Lizabeth J, Vegunta, Ravindra K
• Format: Article
• Language: English
• Subjects: Abscess; Abscess - diagnosis; Abscess - microbiology; Abscess - surgery; Adolescent; Child; Child, Preschool; Cohort Studies; Drainage; Drainage - methods; Female; Follow-Up Studies; Humans; Infant, Newborn; Male; Minimally invasive; Minimally Invasive Surgical Procedures - methods; Pediatric; Pediatrics; Retrospective Studies; Risk Assessment; Severity of Illness Index; Skin Diseases - diagnosis; Skin Diseases - microbiology; Skin Diseases - surgery; Staphylococcal Skin Infections - diagnosis; Staphylococcal Skin Infections - surgery; Subcutaneous abscess; Surgery; Technique; Treatment Outcome; Young Adult
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2009.06.013

Abstract Purpose The aim of the study was to evaluate outcomes after a minimally invasive approach to pediatric subcutaneous abscess management as a replacement for wide exposure, debridement, and repetitive packing. Methods A retrospective study was performed of all children who underwent incision and loop drainage for subcutaneous abscesses between January 2002 and October 2007 at our institution. Technique Two mini incisions, 4-5 mm each, were made on the abscess, as far apart as possible. Abscess was probed, and pus was drained. Abscess was irrigated with normal saline; a loop drain was passed through one incision, brought out through the other, and tied to itself. An absorbent dressing was applied over the loop and changed regularly. Results One hundred fifteen patients underwent drainage procedures as described; 5 patients had multiple abscesses. Mean values (range) are as follows: age, 4.25 years (19 days to 20.5 years); duration of symptoms, 7.8 days (1-42 days); length of hospital stay, 3 days (1-39 days); duration of procedure, 10.8 minutes (4-43 minutes); drain duration, 10.4 days (3-24 days); and number of postoperative visits, 1.8 (1-17). Bacterial culture data were available for 101 patients. Of these, 50% had methicillin-resistant Staphylococcus aureus , 26% had methicillin-sensitive Staphylococcus aureus , and 9% streptococcal species. Of the 115 patients, 5 had pilonidal abscesses, 1 required reoperation for persistent drainage, and 1 had a planned staged excision. Of the remaining 110 patients, 6 (5.5%) required reoperation—4 with loop drains and 2 with incision and packing with complete healing. Conclusion The use of loop drains proved safe and effective in the treatment of subcutaneous abscesses in children. Eliminating the need for repetitive and cumbersome wound packing simplifies postoperative wound care. Furthermore, there is an expected cost savings with this technique given the decreased need for wound care materials and professional postoperative home health services. We recommend this minimally invasive technique as the treatment of choice for subcutaneous abscesses in children and consider it the standard of care in our facility.