Loop vs. Traditional Incision and Drainage: A Randomized Controlled Pilot Trial

BACKGROUND AND SIGNIFICANCE

The usual care in the United States for abscess management is generally incision and drainage. There have been various techniques described for incision and drainage: 1. incision and drainage followed by healing by secondary intention, 2. Incision and drainage followed by primary closure, and 3. Loop drainage (more recently, the topic of this study) with subsequent loop removal and healing by secondary intention. The treatment failure rate for traditional incision and drainage is variable, but can range from 10-30%. Costs associated with treatment failure are between $1,000 and $2,0005. The relatively high failure rate associated with traditional incision and drainage has led to research into less invasive, more effective techniques. In 2010, the loop drainage technique was first described. This technique consists of making 2 small incisions on either end of the abscess cavity followed by pulling a small drain through the incisions and then tying the drain in place. It remains in place and is removed once no further drainage is noticed (usually in 10-14 days). Original studies were primarily done by pediatric surgeons using vessel loops or penrose drains.

In 2014, the concept of using the cuff from the bottom of a sterile glove was introduced. This allows for this technique to easily be used with materials found easily in any emergency department. The amount of research done with this technique on adults is limited. To date, only two studies with a total of 109 patients evaluated loop drainage in adults. One of these studies was retrospective and included only 63 patients. The other prospective study was limited in that it included only 46 patients. Given the demonstration of increased clinical cure rate in pediatric populations and the potential for increased clinical cure rates in adults, more study into this topic is worthwhile to determine the optimal approach to adult subcutaneous abscess drainage.

STUDY DESCRIPTION

This study will be a pilot study and multi-center prospective randomized controlled trial evaluating loop drainage compared to conventional incision and drainage in adults older than 18 who have simple, purulent, cutaneous abscesses deemed amenable to outpatient incision and drainage by the attending clinician.