Randomized trial comparing wound packing to no wound packing following incision and drainage of superficial skin abscesses in the pediatric emergency department.

OBJECTIVE

The objective of this study was to investigate the impact of wound packing versus no wound packing on short-term failure rates and long-term recurrences after incision and drainage (I&D) of a simple cutaneous abscess.

METHODS

In this randomized, single-blind, prospective study, subjects between the ages 1 and 25 years with skin abscesses needing an I&D were enrolled consecutively and randomized to be packed or not packed following the procedure. Treatment failure was assessed at a 48-hour follow-up visit by a masked observer who rated the need for a major intervention (repeat I&D or re-exploration) or minor intervention (antibiotics initiated or changed, need for packing, or repeat visit). Pain scores were assessed using color analog scales before and after the procedure and repeated at the 48-hour follow-up visit. Healing and abscess recurrence were assessed via telephone interview at 1 week and 1 month.

RESULTS

Fifty-seven subjects were enrolled over a 15-month period. Overall failure rates were similar between the groups, with 19 (70%) of 27 subjects in the packed group needing an intervention by 48 hours compared with 13 (59%) of 22 subjects in the nonpacked group who needed an intervention (difference, 11%; 95% confidence interval, -15% to 36%). Major and minor intervention rates were also similar. Pain scores did not significantly differ between groups.

CONCLUSIONS

Wound packing does not appear to significantly impact the failure or recurrence rates after simple I&D. Larger studies are needed to better validate the equivalency of these 2 strategies.