Abscesses are already painful and can cause scars, so why don’t we try a cool move to minimize this for patients? Loop drainage has come to the forefront due to lower failure rates, less scaring, continuous draining, and no need for packing/repacking!
How is it done? (https://www.youtube.com/watch?v=hkEidzzs0JY)
1. Numb the abscess with lidocaine +/- epi (keeping in mind the toxic dose of ~4.5 mg/kg )
2. Make two small incisions on opposite sides of the abscess
3. Place Kelly clamps through the holes and break up the loculations
4. Run a loop through both holes and tie it in a knot. Don’t tie the knot tight, just needs to to stay together.
Don’t have a silicone vascular loop? You can also use Penrose drain or finger of a glove.
Does it really work? Yeah, https://www.ncbi.nlm.nih.gov/pubmed/28917436. This technique shows lower failure rates, especially in children.
A reliable patient can even take it out themselves. And an unreliable patient now has a reason to return to the ED for wound check. If you’re doing one of these in the next month, keep your TR in the loop!