Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 7  |  Issue : 6  |  Page : 744-747  

A comparative study of conventional incision and drainage versus incision and drainage with primary closure of the wound in acute abscesses


Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Date of Web Publication18-Nov-2014

Correspondence Address:
Aniruddha Kale
Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.144864

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  Abstract 

Purpose: Acute soft tissue abscess is a very common condition. This study was undertaken to compare the outcome of conventional incision and drainage versus incision and drainage with primary closure of wound in acute abscesses with regards to better healing rate, less postoperative pain, less hospital stay, low cost of treatment, and less recurrence rate. Introduction: Acute soft tissue abscesses are common conditions in surgical practice. The established principle of surgical management of abscesses has been incision and drainage. This modality of treatment has been challenged with the introduction of antibiotics. The aim of our study was to compare the conventional method of incision and drainage with the alternative method of incision and drainage with primary closure and negative suction drain. Materials and Methods: In our study, 100 patients admitted with superficial abscess excluding patient suffering from systemic diseases. Deep seated abscesses (e.g., intra-abdominal abscess, pelvic), abscess cavity of internal diameter of >5 cm. Patients were randomly divided into two groups. Group A included 50 patients treated by conventional incision and drainage; Group B included 50 patients treated by the incision and drainage with Primary closure and negative suction drain. Patient were assessed during the hospital stay and follow-up on following criteria for postoperative pain by visual analog score, days of hospital stay, wound healing, treatment cost and recurrence. Results: A total of 100 patients were randomized to primary or secondary closure. The time of wound healing, length of hospital stay and postoperative pain were less for Group B patients than in Group A patients. Results found significant pertaining to wound healing, postoperative pain, days of hospital stay treatment cost and recurrence in Group B than Group A. Conclusion: In our study, incision and drainage with primary closure combined with use negative suction drain is more effective than that of incision and drain.

Keywords: Acute abscess, comparative study of abscess treatment, I and D versus primary closure


How to cite this article:
Kale A, Athavale V, Deshpande N, Nirhale D, Calcuttawala M, Bhatia M. A comparative study of conventional incision and drainage versus incision and drainage with primary closure of the wound in acute abscesses. Med J DY Patil Univ 2014;7:744-7

How to cite this URL:
Kale A, Athavale V, Deshpande N, Nirhale D, Calcuttawala M, Bhatia M. A comparative study of conventional incision and drainage versus incision and drainage with primary closure of the wound in acute abscesses. Med J DY Patil Univ [serial online] 2014 [cited 2024 Mar 28];7:744-7. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2014/7/6/744/144864


  Introduction Top


Acute soft tissue abscesses are common conditions in our environment. [1] For the treatment of skin and soft tissue abscesses, options include repeated aspiration, incision and drainage, incision and drainage with primary closure and conservatively treated by giving antibiotics. The established principle of surgical management of abscesses has been incision and free drainage; this permits healing by secondary intention or treatment by secondary closure. [2] This modality of treatment has been challenged with the introduction of antibiotics. Ellis taught that the abscess wall prevented access of blood-borne antibiotics to the abscess cavity and that if this wall was curetted away the cavity could fill with antibiotic-laden blood clot, permitting safe primary closure. The primary closure technique is supported by many surgeons who showed its effectiveness in the treatment of breast, anorectal, axillary abscesses. [3] Advantages of primary closure technique are faster healing rate, less hospital stay and early return to work, no greater recurrence than the conventional method, better scar formation and finally reduced cost of labor and material and may be recommended as an alternative treatment that is superior to the orthodox technique. [4] In our study, we compared the outcome of conventional incision and drainage of acute abscesses versus incision and drainage with primary closure of wound in acute abscesses.

Hence, we performed a comparative study of the conventional method of incision and drainage with primary closure of the wound in acute abscesses with regards to wound healing, postoperative pain, duration of hospital stay, cost of treatment, and recurrence.


  Materials and Methods Top


A comparative prospective study included 100 cases of acute abscesses at Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune. Institutional Ethical Committee Clearance was obtained for the study. Informed consent was obtained from all the patients before inclusion in the study. All patients with acute superficial abscesses attending surgical OPD and casualty were included. Patient suffering from systemic diseases like diabetes mellitus, immunodeficiency, anemia, etc. Patients on steroids, deep seated abscesses (e.g., intra-abdominal abscess, pelvic, thoracic, intracranial abscess), and abscess cavity of internal diameter of >5 cm were excluded. Patients were divided into two groups. Group A includes conventional incision and drainage and Group B includes incision, drainage and primary closure with negative suction drain. First case was allotted, by lottery method and patients were assigned into one group and subsequent patients into alternate groups. Patients were prepared preoperatively. Anesthesia was given depending on the site and age. Injection amoxicillin (1000 mg) + potassium clavulanate (200 mg) 1.2 g intravenous (I.V.) given before induction of anesthesia and postoperatively. In both groups, injection amoxicillin (1000 mg) + potassium clavulanate (200 mg) 1.2 g I.V. given 12 hourly for 2 days and then continued with tablet for 3 more days until culture reports were available and then as per culture sensitivity report antibiotics were changed accordingly for next 5 days. In both groups, injection diclofenac sodium 3cc (75 mg) was given stat intramuscular (IM) and then continued with tablet diclofenac sodium twice a day for 3 days. Suction drain was removed after discharge from abscess cavity was minimal (<5 mL/day) and the sutures were removed between 7 th and 14 th day. The average duration of drain removal was 7 days. Postoperatively wound healing assessment done in Group A: Healing time was recorded from time of incision until the complete obliteration of abscess cavity. In Group B: Healing time was recorded from time of incision until suture removal after confirming that skin edges were properly approximated. Pain assessment was done by visual analog score (VAS) in both groups.


  Results Top


The maximum number of patients in Groups A and B were in the age group 21-30 years. In Group A, of 50 cases, 27 were males and 23 were females. In Group B, 31 were males and 19 were females. The age and gender distributions are shown in [Table 1] & [Table 2] respectively.

Wound healing

Wound healing in Group B was faster than in Group A. Wound healing was analyzed quantitatively within group. The Z value is 13.52. And, P value is statistically highly significant (P < 0.0015) [Table 3] and [Graph 1].



Visual analog score

This mean VAS was analyzed quantitatively within both groups. There was a significant difference in both groups, which is statistically highly significant (P < 0.0001) [Table 4] and [Graph 2].

Hospital stay

Hospital stay was less in Group B than in Group A [Table 5] and [Graph 3].

Cost of treatment

There was a significant difference between the total protocol costs (P < 0.001). Cost of treatment in Group A was more (929.1 ± 235.64) as compared to Group B (584.91 ± 162.57) [Table 6] and Graph 4].

Recurrence

Recurrence was found 3 times more in Group A than in Group B [Table 7] and [Graph 5]. The recurrence of abscess in Group A was more (three cases) as compared to Group B (one case). Recurrence in Group A was at three different sites (gluteal region, axilla, and breast), while in Group B, recurrence was in a breast abscess. In both groups, the recurrence was at the primary site.
Table 1: Age-wise distribution of cases in Groups A and B

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Table 2: Gender-wise distribution of cases in Groups A and B

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Table 3: Comparison of wound healing in Groups A and B

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Table 4: Day-wise comparison of VAS in Groups A and B

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Table 5: Comparison of hospital stay in Groups A and B

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Table 6: Comparison of cost in Group A and Group B

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Table 7: Recurrence of cases in Groups A and B

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  Discussion Top


A total of 100 patients were divided into two groups. The comparison was done in regards to wound healing, postoperative pain, hospital stay, cost of treatment, and recurrence. In our study, wound healing was compared between the two groups. Wound healing was significantly faster in Group B as compared with Group A (<0.0015). A study done by Dubey and Choudhary correlates with our study. In their study, they found that wound healing was faster in acute abscesses treated with primary closure than in in conventional incision and drainage. [5] In our study, postoperative pain assessment was done by VAS. On comparing both groups in our study, to attain mild (0-3) VAS patients in Group B needed 3-4 days as compared to 6-7 days in Group A. Similar finding was observed in a study conducted by Abraham et al. [4] In our study, mean hospital stays in Group B was less than in Group A. Mean hospital stay was significantly less in Group B as compared with Group A. Similar finding was observed in a study conducted by Abraham et al. they found that hospitalization was reduced by 40-60% in group with closure of superficial abscess. [4] In our study, mean cost of incision and drainage of an abscess was significantly less in Group B as compared to Group A and findings were consistent with the study done by Edino et al. they found that cost of treatment was less in group treated with primary closure of acute abscesses than in group treated with conventional incision and drainage. [1] In our study, recurrence rate was 3 times more in Group A as compared with Group B. Similar finding was seen in a study conducted by Khanna et al. [6]


  Conclusion Top


Incision and drainage with primary closure technique was associated with faster wound healing, less postoperative pain, less hospital stay, low cost of treatment, and low recurrence rate than conventional incision and drainage. Primary closure with negative suction drain is a better alternative technique over the conventional incision and drainage method of acute abscesses.

 
  References Top

1.
Edino ST, Ihezue CH, Obekpa PO. Outcome of primary closure of incised acute soft-tissue abscesses. Niger Postgrad Med J 2001;8:32-6.  Back to cited text no. 1
    
2.
Gajiwala KJ. Puncture, drainage and irrigation: Is that enough for treating an abscess? Indian J Plastic Surg 2006;39:189-95.  Back to cited text no. 2
    
3.
Ellis M. Incision and primary suture of abscesses of the anal region. Proc R Soc Med 1960;53:652-3.  Back to cited text no. 3
[PUBMED]    
4.
Abraham N, Doudle M, Carson P. Open versus closed surgical treatment of abscesses: A controlled clinical trial. Aust N Z J Surg 1997;67:173-6.  Back to cited text no. 4
    
5.
Dubey V, Choudhary SK. Incision and drainage versus incision and drainage with primary closure and use of closed suction drain in acute abscesses. Wounds 2013;25:58-60.  Back to cited text no. 5
    
6.
Khanna YK, Khanna A, Singh SP, Laddha BL, Prasad P, Jhanji RN. Primary closure of gluteal injection abscess (a study of 100 cases). J Postgrad Med 1984;30:105-10.  Back to cited text no. 6
[PUBMED]  Medknow Journal  



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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Abstract
Introduction
Materials and Me...
Results
Discussion
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