STOP PACKING ABSCESS: A RANDOMIZED CLINICAL TRIAL COMPARING PACKING WITH NON PACKING OF THE ABSCESS CAVITY


Kumar A, Shah S P, Agrawal C S, Agrawal S

ABSTRACT

Background and objective(s): Traditionally, it was a routine practice to place packing in the abscess cavity following I&D but this concept is changing.This study was conducted to determine more systematically whether routine packing of skin and soft tissue abscess following I&D confers any benefit over I&D followed by simple absorbent dressing alone.

Materials and Methods: Subjectswere randomized to either packing or non-packing groups. Treatment failure was assessed at 48-hr follow-up by a masked observer who rated it as major (repeat I&D or re-exploration or packing the cavity) or minor (further follow up needed). Pain scores were assessed before the procedure,after the procedure and at 48 hr follow-up visit. Healing was assessed at weekly interval using Bates-Jensen tool and cosmesis at 1week using VAS.

Results: Total 104 subjects were enrolled. There were no significant differences in baseline characteristics and wound cosmesis between the two groups. The risk of minor treatment failure was almost double in packing than non-packing group (80.8% versus 40.4%, P=0.001). Patients in packing reported higher pain scores at 48 hours follow up (mean difference = 1.361cm; p = 0.001, 95% CI = 1.095 to 1.628 cm).Wound healing was faster in non-packing than packing group at both 1 week (mean difference = 4.46; p = 0.001, 95% CI = 2.289 to 5.966) and 2 weeks(mean difference = 1.18; p = 0.049, 95% CI = -0.418 to 1.921).

Conclusion: Non-packing of abscess cavity significantly reduced minor treatment failure rate andpain perceived

Key words:I&D (Incision and Drainage), Packing, Non-packing, treatment failure.

Conflict of interest: None of the authors is having any conflict of interest.