Rafael Gaszynski1, Gratian Punch2, Kurt Verschuer1. 1. Department of General Surgery, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia. 2. Department of General Surgery, Lismore General Hospital, Lismore, New South Wales, Australia.
Abstract
BACKGROUND: This study evaluated the safety, efficacy and compliance of an emerging technique for managing complex subcutaneous abscesses in an adult population (≥16 years). METHODS: A retrospective review of prospectively collected data between April and October 2015 at a rural hospital comparing conventional incision drainage (CID) and repetitive packing to the minimal incision, irrigation, loop and drain technique (LDT). LDT method was consistent with previous publications, being ≤5 mm incisions at abscess edges, irrigation and passage of a VessiLoop through the cavity and then secured above the skin. The loop remained in situ until resolution. Both groups had empirical oral antibiotics. RESULTS: Sixty-three patients required intervention for complex subcutaneous abscess: CID group had 27 patients and LDT had 36 patients. The mean age of CID group was 43.9 years (range: 16-86 years), all required intervention in theatre with 10 patients lost to follow-up (37%) and the remaining 17 required a mean of 11.8 (range: 1-17) care visits. The mean age of LDT group was 34.9 years (range: 16-62 years), 11 completed intervention in ED under local anaesthetic (30%) and 27 required general anaesthesia. Compliance to follow-up clinic was 100%: 27 seen once at 10-14 days with loop removal and nine were seen a second time to complete care. There were no re-operations. CONCLUSION: This is the first LDT data in adults and proves it is safe and effective. It saves operating theatre time with 30% of LDT treated in the Emergency Department and ensures excellent follow-up compliance as patients return for VessiLoop removal. Healthcare burden is greatly reduced using LDT; most patients require only one review at 10-14 days.
BACKGROUND: This study evaluated the safety, efficacy and compliance of an emerging technique for managing complex subcutaneous abscesses in an adult population (≥16 years). METHODS: A retrospective review of prospectively collected data between April and October 2015 at a rural hospital comparing conventional incision drainage (CID) and repetitive packing to the minimal incision, irrigation, loop and drain technique (LDT). LDT method was consistent with previous publications, being ≤5 mm incisions at abscess edges, irrigation and passage of a VessiLoop through the cavity and then secured above the skin. The loop remained in situ until resolution. Both groups had empirical oral antibiotics. RESULTS: Sixty-three patients required intervention for complex subcutaneous abscess: CID group had 27 patients and LDT had 36 patients. The mean age of CID group was 43.9 years (range: 16-86 years), all required intervention in theatre with 10 patients lost to follow-up (37%) and the remaining 17 required a mean of 11.8 (range: 1-17) care visits. The mean age of LDT group was 34.9 years (range: 16-62 years), 11 completed intervention in ED under local anaesthetic (30%) and 27 required general anaesthesia. Compliance to follow-up clinic was 100%: 27 seen once at 10-14 days with loop removal and nine were seen a second time to complete care. There were no re-operations. CONCLUSION: This is the first LDT data in adults and proves it is safe and effective. It saves operating theatre time with 30% of LDT treated in the Emergency Department and ensures excellent follow-up compliance as patients return for VessiLoop removal. Healthcare burden is greatly reduced using LDT; most patients require only one review at 10-14 days.