Minimally invasive technique in treatment of complex, subcutaneous abscesses in children.
The rising prevalence of community-acquired, methicillin-resistant Staphylococcus aureus (MRSA) has correlated with an escalating number of complex, subcutaneous abscesses in pediatric patients. The purpose of this study was to present a novel technique and early outcome results for the minimally invasive drainage of complex, subcutaneous abscesses.


METHODS
Patients' outcomes from the treatment of complex, subcutaneous abscesses were retrospectively reviewed under institutional review board approval from July 2006 to August 2007 at 2 independent, tertiary care pediatric hospitals. Data on patients' demographics, length of hospital stay, and length of treatment were collected, along with analysis of the isolated organisms. The operative technique uses drainage of the abscess through peripheral stab incisions. Cavity debridement and irrigation is followed by placement of a vessel-loop drain through the drainage incisions. Topical wound care without packing is performed twice a day. Drain removal follows resolution of cellulitis and drainage.


RESULTS
One hundred twenty-eight patients were treated over a 14-month period. The ratio of females to males was 1.25:1. Average patient age was 51.5 months (median, 21 months) and ranged from 5 weeks to 18 years. The average length of hospital stay was 1.5 days, though 30 patients were treated on an outpatient basis. Methicillin-resistant Staphylococcus aureus was identified in 76% of the cultured specimens. Average length of drain use was 9 days (range, 5-29 days). There were no local recurrences of subcutaneous abscesses. There was no morbidity related to the drainage procedures.


CONCLUSIONS
We present a successful technique for the drainage and treatment of complex abscesses in children with limited, postoperative wound care and no morbidity or recurrence.
Ladd
Alan P
AP
Division of Pediatric Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA. aladd@iupui.edu
Levy
Marc S
MS
Quilty
Jennifer
J
D000038:Abscess / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D019060:Minimally Invasive Surgical Procedures; D009336:Necrosis; D012189:Retrospective Studies; D017592:Skin Care; D013207:Staphylococcal Skin Infections / Q000473:pathology / Q000601:surgery*; D040521:Subcutaneous Tissue / Q000473:pathology; D007507:Therapeutic Irrigation