Primary Versus Secondary Closure of Cutaneous Abscesses in the Emergency Department: A Randomized Controlled Trial. (13th January 2013)

• Record Type: Journal Article
• Authors: Singer, Adam J.; Taira, Breena R.; Chale, Stuart; Bhat, Rahul; Kennedy, David; Schmitz, Gillian; Zehtabchi, Shahriar
• Is Part Of: Academic emergency medicine. Volume 20:Number 1(2013:Jan.)
• Page Start: 27
• Page End: 32
• Publication Date: 2013-01-13
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.12053
• Languages: English
• ISSNs: 1069-6563

Abstract

<abstract abstract-type="main" xml:lang="en" id="acem12053-abs-0001"> <title>Abstract</title> <sec id="acem12053-sec-0001" sec-type="section"> <title>Objectives</title> <p>Cutaneous abscesses have traditionally been treated with incision and drainage (I&D) and left to heal by secondary closure. The objective was to compare the healing rates of cutaneous abscesses following I&D after primary or secondary closure.</p> </sec> <sec id="acem12053-sec-0002" sec-type="section"> <title>Methods</title> <p>This was a randomized, controlled, trial, balanced by center, with blocked randomization created by a random‐number generator. One urban and one suburban academic emergency department (ED) participated. Subjects were randomized to primary or secondary wound closure following I&D of the abscess. Main outcome measures were the percentage of healed wounds (wound was completely closed by visual inspection; a 40% difference in wound healing was sought) and overall failure rate (need for additional intervention including suture removal, additional drainage, antibiotics, or admission within 7 days after drainage).</p> </sec> <sec id="acem12053-sec-0003" sec-type="section"> <title>Results</title> <p>Fifty‐six adult patients with simple localized cutaneous abscesses were included; 29 were randomized to primary closure, and 27 were randomized to secondary closure. Healing rates at 7 days were similar between the primary and secondary closure groups (69.6%, 95% confidence interval [CI] = 49.1% to 84.4% vs. 59.3%, 95% CI = 40.7% to 75.5%; difference 10.3%, 95% CI = −15.8% to 34.1%). Overall failure rates at 7 days were also similar between the primary and secondary closure groups (30.4%, 95% CI = 15.6% to 50.9% vs. 28.6%, 95% CI = 15.2% to 47.1%; difference 1.8%, 95% CI = −24.2% to 28.8%).</p> </sec> <sec id="acem12053-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The rates of wound healing and treatment failure following I&D of simple abscesses in the ED are similar after primary or secondary closure. The authors did not detect a difference of at least 40% in healing rates between primary and secondary closure.</p> </sec> </abstract>