I’ll post a more “official” article and review later in the month but I came across this article about abscesses and thought it was interesting. Skin abscesses are not the sexiest topic but we treat them frequently so it would be worth considering a practice change if it improved patient comfort and/or outcome.

The SGEM post and podcast (link below) summarizes the article and does a critical appraisal. Original article is posted here: https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14106

Essentially they looked at treatment failure as a primary outcome after treatment of skin abscesses with the loop technique versus standard packing with ribbon gauze. Secondary outcomes were ease of procedure, pain at the time of treatment, ease of care at 36 hours, and pain at 36 hours.

Study conclusion was:

“The LOOP and packing techniques had similar failure rates for treatment of subcutaneous abscesses in adults, but the LOOP technique had significantly fewer failures in children. Overall, pain and patient satisfaction were significantly better in patients treated using the LOOP technique.”

A few thoughts/questions:

What is everyone’s usual practice? Packing vs. no packing vs. leaving a small wick? Has anyone tried this loop technique?

Do we even stock vessel ties in the ER?

Given the questionable evidence regarding packing, wouldn’t it be easier to just not pack at all (ie. no loop or standard packing)?