The loop technique: a novel incision and drainage technique in the treatment of skin abscesses in a pediatric ED

A Randomized Controlled Trial of Novel Loop Drainage Technique Versus Standard Incision and Drainage in the Treatment of Skin Abscesses

“…The LOOP group underwent I&D as described in previous literature using a vessel tie loop. 6 The standard packing group was packed with sterile ribbon gauze. Both groups had procedural consents and skin preps per protocol.…”

“…The LOOP technique, in which one or multiple vessel loops is placed in through the abscess cavity, is an alternative to traditional packing that still allows the abscess cavity to continue to drain. [6][7][8][9] Most providers follow standard I&D with wound packing. 2,4 Traditionally, this is believed to prevent premature wound margins from closing and promote continued drainage, although evidence for this is limited, and recent investigations have questioned the necessity of packing.…”

“…4 The LOOP technique offers an alternative to packing that does not require large incisions and can be used in small and large abscesses, preventing premature closure and promoting continued drainage in a manner similar to packing. 6,11 A vessel loop is placed into the abscess cavity through two small incisions after loculations are bluntly opened and the cavity is irrigated. The vessel loop is tied loosely and left in place for several days so that the wound can drain and then removed by cutting the vessel loop and gently retracting it from the wound (Figure 1).…”

Emergency department management of skin and soft tissue abscesses

“…Proposed benefits of the loop technique include reduced pain, no need for painful packing changes, simplified follow‐up and improved cosmesis. Retrospective reviews of paediatric patients have shown loop drainage to be as safe and efficacious as open I + D . The authors caution that retrospective demonstration of non‐inferiority of this novel technique should not necessarily prompt widespread change of practice.…”

“…This technique involves making two small stab incisions at each end of the abscess, opening the loculations to drain all pus, then inserting a subcutaneous drain through the two incisions and tying the ends in a loop. Discharge instructions include taking a bath/shower twice daily for the first 3 days, followed by removal of the loop in 7–10 days, or when the drainage stops and any overlying cellulitis has resolved . A video describing the technique is available at Academic Life in Emergency Medicine – http://www.aliem.com/trick-of-the-trade-incision-and-loop-drainage-of-abscesses/ .…”