For those of you who are still making 5 cm incisions and packing with 12 feet of ribbon gauze, 2009 called… it wants its scalpel back. Introducing the I&LD (Loop Drainage). On your next I&D, try this less invasive method. Reported to be less painful both initially and after discharge, with less scarring and similar success rates to the old school slash and pack technique.
1) Stab 5mm incision and probe all around abscess to find edges and break loculations.
2) Insert hemostat into incision #1 and indent skin from within at site of incision #2 and make second stab incision with max width between the two of 4cm.
3) Irrigate abscess (can insert an angiocath or blunt tip of a tumi or regular syringe)
4) Thread loop drain through 2 incisions.
5) Tie loop drain loosely over the skin. Too tight and can get pressure necrosis of skin.
6) Remove drain after drainage stops and cellulitis resolves (7-10 days). Can also instruct patient to move knot from one side to the other to prevent adhesion of the loop to the skin and to promote drainage.
7) Remember, there is plenty of evidence to support I&D only without the the use of po antibiotics.
Tricks of the Trade:
But, what if you don’t have a vessel loop in your ED? From Academic Life in EM
Use a trimmed sterile tourniquet as the loop. Trim the tourniquet longitudinally. This strip was long and thin enough to allow us to tie a non-tensile loop through the abscess.
Another trick of the trade mentioned on EMBroadSpectrum.com: Cut off the vacutainer and needle of the two ends of a butterfly and use the tubing instead of the vessel loop.
Tsoraides SS, Pearl RH, Stanfill AB, Wallace LJ, Vegunta RK. Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children. J Pediatr Surg. 2010 Mar;45(3):606-9. Pubmed.