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Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children
Steven S Tsoraides1, Richard H Pearl, Amy B Stanfill
1Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL 61603, USA.
Insights
Minimally invasive loop drainage is a safe and effective treatment for pediatric subcutaneous abscesses. This technique simplifies wound care, reduces costs, and is recommended as the standard of care.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
Background:
- Subcutaneous abscesses are common in children.
- Traditional management involves wide incision, debridement, and repetitive packing, which can be burdensome.
Purpose of the Study:
- To evaluate the outcomes of a minimally invasive approach using loop drainage for pediatric subcutaneous abscesses.
- To compare this technique with traditional methods.
Main Methods:
- Retrospective study of 115 children treated with incision and loop drainage between 2002 and 2007.
- Two small incisions were made for pus drainage and loop insertion.
- Abscesses were irrigated, and a loop drain was placed and secured.
Main Results:
- The procedure was performed on 115 children, with a mean age of 4.25 years.
- The most common pathogen was methicillin-resistant Staphylococcus aureus (50%).
- A low reoperation rate of 5.5% was observed, with complete healing in most cases.
Conclusions:
- Loop drainage is a safe and effective minimally invasive technique for pediatric subcutaneous abscesses.
- It simplifies postoperative care and offers potential cost savings.
- This method is recommended as the standard of care for pediatric subcutaneous abscesses.
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.
