Author: Dr. Ramsay, PGY-1 Emergency Medicine, Rush University Medical Center

Title of article: A randomized controlled trial of novel loop drainage technique versus standard incision and drainage in the treatment of skin abscesses

Citation: Ladde, J., Baker, S., Lilburn, N., Wan, M., & Papa, L. (2020). A randomized controlled trial of novel loop drainage technique versus standard incision and drainage in the treatment of skin abscesses. Academic Emergency Medicine.


  • 1.4 million I&D’s each year in the United States (Baumann et al)
  • Packing is controversial (O’Malley et al)
  • Packing can be painful
  • Antibiotic use is of limited benefit in uncomplicated abscess (List et al)

Study Question:

How does the failure rate of incision and drainage with LOOP technique compare to I&D with standard packing technique in adults and children presenting to the emergency department with subcutaneous abscess?

Design :

  • Study type: prospective, randomized controlled trial
  • Patient Allocation: convenience sample 
  • Location of Study: two level 1 trauma centers
  • Inclusion criteria: any age, presenting with subQ abscess between March 14, 2009 and April 10, 2010
  • Exclusion criteria: abscess of hand, foot, or face. Or if required admission or operative treatment

Study design:                                            

  • randomized, numbered, sealed envelopes taken in sequential order. 
  • contents of envelope not revealed until after patient consented.   


  • Similar failure rates in adults, but loop technique had 0% failure rate in children.
  • Also, loop performed better when measuring ease of procedure, pain, ease of care and pain over 36 hours, patient satisfaction at 10 days, with the last 3 outcomes being significant


  • Strengths: Similar characteristics in both groups
  • Randomized, blinded
  • ED setting


  • Only 2 hospitals
  • Convenience sample only when investigators available
  • Not double blinded (but can’t really double blind this procedure)
  • Packing may not be the standard at other institutions
  • Pain/ease scores may be better without packing
  • No comparison to I&D without any packing
  • Abx and sedation was at the discretion of physician
  • Techniques are user dependent

Application to my practice:

  • Loop appears to be a safe alternative in adults
  • Perhaps a better alternative in children
  • Harder to remove a loop compared to packing?
  • Perhaps kids play around with the packing?

Take Away:

Loop or no loop, both seem to be fairly good options and I’ll probably try the loop technique next time I have a pediatric patient with an abscess I need to drain

Loop technique (from Ladde et al)

  1. Anesthesia, incision, hemostat
    1. Tent skin, second incision
    1. Irrigate, hemostat through, pull
    1. Pull vessel loop through cavity
    1. Tie loop loosely
    1. Final product


  • Gaszynski, R., Punch, G., & Verschuer, K. (2018). Loop and drain technique for subcutaneous abscess: a safe minimally invasive procedure in an adult population. ANZ journal of surgery, 88(1-2), 87-90.
  • Baumann, B. M., Russo, C. J., Pavlik, D., Cassidy-Smith, T., Brown, N., Sacchetti, A., … & Mistry, R. D. (2011). Management of pediatric skin abscesses in pediatric, general academic and community emergency departments. Western Journal of Emergency Medicine, 12(2), 159.
  • O’Malley, G. F., Dominici, P., Giraldo, P., Aguilera, E., Verma, M., Lares, C., … & Williams, E. (2009). Routine packing of simple cutaneous abscesses is painful and probably unnecessary. Academic Emergency Medicine, 16(5), 470-473.
  • List, M., Headlee, D., & Kondratuk, K. (2016). Treatment of Skin Abscesses: A Review of Wound Packing and Post-Procedural Antibiotics. South Dakota Medicine, 69(3).
  • Ladde, J. G., Baker, S., Rodgers, C. N., & Papa, L. (2015). The LOOP technique: a novel incision and drainage technique in the treatment of skin abscesses in a pediatric ED. The American Journal of Emergency Medicine, 33(2), 271-276.

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