title: Primary versus secondary closure of cutaneous abscesses in the emergency department: a randomized controlled trial.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA. adam.singer@stonybrook.edu
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.forename: Breena R
authors.initials: BR
authors.lastname: Taira
authors.forename: Stuart
authors.initials: S
authors.lastname: Chale
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhat
authors.forename: David
authors.initials: D
authors.lastname: Kennedy
authors.forename: Gillian
authors.initials: G
authors.lastname: Schmitz
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D016001:Confidence Intervals; D004322:Drainage / Q000379:methods*; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012871:Skin Diseases / Q000175:diagnosis / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult