Primary Versus Secondary Closure of Cutaneous Abscesses in the Emergency Department: A Randomized Controlled Trial

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Abstract

Objectives:

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.

Methods:

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).

Results:

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%).

Conclusions:

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.

Cierre Primario Versus Cierre Secundario de los Abscesos Cutaneos en el Servicio de Urgencias: Ensayo Clinico Controlado con Asignación Aleatoria

Objetivos

Los abscesos cutSymbolneos se han tratado tradicionalmente con incisión y drenaje y se ha dejado la curación para un segundo cierre. El objetivo fue comparar el porcentaje de curación de los abscesos cutSymbolneos tras incisión y drenaje después de cierre primario o secundario.

Método

Ensayo clSymbolnico controlado con asignación al azar balanceado por centro, con asignación aleatoria bloqueada creada por un generador de número al azar. Participaron dos servicios de urgencias universitarios, uno urbano y otro suburbano. Se incluySymbol a 56 pacientes adultos con abscesos de piel simples localizados: 29 se asignaron a cierre primario y 27 a cierre secundario. Las intervenciones incluyeron cierre primario o secundario de la herida tras la incisión y drenaje del absceso. Las principales variables resultado fueron el porcentaje de heridas curadas (la herida estaba completamente cerrada a la inspección visual) y el porcentaje de fallo global (la necesidad de intervención adicional que incluiSymbol la retirada de la sutura, el drenaje adicional, los antibióticos o el ingreso en los primeros siete días primeros tras el drenaje).

Resultados

El porcentaje de curación a los siete dSymbolas fue similar entre los grupos de cierre primario y secundario (69,6% [IC 95% = 49,1% a 84,4%] vs. 59,3% [IC 95% = 40,7% a 75,5%]; diferencia 10,3% [IC 95% = −15,8% a 34,1%]). El porcentaje de fallo global a los siete dSymbolas fue también similar entre los grupos de cierre primario y secundario (30,4% [IC 95% = 15,6% a 50,9%] vs. 28,6% [IC 95% = 15,2% a 47,1%]; diferencia 1,8% [IC 95% = −24,2% a 28,8%]).

Conclusiones

Los porcentajes de curación de heridas y de fallo de tratamiento conseguidos mediante incisión y drenaje de abscesos simples en el servicio de urgencias son similares tras el cierre primario o secundario. No se documentó una diferencia de al menos el 40% en los porcentajes de curación entre el cierre primario y secundario.

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