Incision and Loop Drainage versus Conventional Incision and Drainage for Subcutaneous Abscess in Children: A Prospective Comparative Study

Abstract

Background: Packing a freshly drained abscess cavity has long been standard practice, yet repeatedly removing that packing causes considerable distress in children and has been linked to slower healing and a higher rate of wound-related complications. Loop drainage, a packing-free alternative, has been put forward as a way to reduce this burden, though direct comparative data from South Asia have so far been limited. Objective: To compare the clinical outcomes of incision and loop drainage with those of conventional incision and drainage in the surgical management of subcutaneous abscess in children. Methods: This prospective comparative study was conducted in the Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital. A calculated target of 84 children per arm was set; 168 children with subcutaneous abscess were enrolled and randomly allocated by lottery method in a 1:1 ratio to Group A (incision and loop drainage) or Group B (conventional incision and drainage with packing). After loss to follow-up, 120 children (60 per arm) completed the study and were analyzed. Length of incision, time to complete drainage, duration of post-operative hospital stay, number of dressings and follow-up visits, wound infection, recurrence, and scar cosmesis (assessed at six months using the Scar Cosmesis Assessment and Rating [SCAR] scale by an assessor not involved in the operation) were compared between groups. Continuous variables were compared using the unpaired t-test or the Mann–Whitney U test according to distribution, and categorical variables using the chi-square or Fisher's exact test; effect sizes with 95% confidence intervals (CIs) and exact p-values are reported, with p < 0.05 considered statistically significant. Results: The two groups were comparable in age, sex, weight, abscess diameter, and anatomical site (p > 0.05). The mean length of incision was significantly shorter in Group A than Group B (2.3 ± 0.4 cm vs 3.3 ± 0.7 cm; mean difference −1.0 cm, 95% CI −1.21 to −0.79, p < 0.001), as was the mean post-operative hospital stay (4.4 ± 1.8 vs 5.3 ± 1.3 days; mean difference −0.9 days, 95% CI −1.47 to −0.33, p = 0.002), the mean number of dressings (3.6 ± 1.5 vs 5.5 ± 3.7; mean difference −1.9, 95% CI −2.93 to −0.87, p < 0.001), and the mean number of post-operative visits (1.6 ± 0.7 vs 2.7 ± 0.8; mean difference −1.1, 95% CI −1.37 to −0.83, p < 0.001). Wound infection (6.7% vs 8.3%; risk difference −1.7%, 95% CI −11.1% to +7.8%, Fisher's exact p = 1.00) and recurrence (5.0% vs 3.3%; risk difference +1.7%, 95% CI −5.5% to +8.8%, Fisher's exact p = 1.00) did not differ significantly between groups; however, the study was underpowered for these rare outcomes, and these results should not be read as evidence of equivalence. A desirable scar (SCAR score 0) was achieved in 55.0% of Group A patients compared with none in Group B (risk difference +55.0%, 95% CI 42.4% to 67.6%, Fisher's exact p < 0.001). Conclusion: In selected children with uncomplicated subcutaneous abscess, incision and loop drainage was associated with a shorter incision length, shorter hospital stay, fewer dressing changes and follow-up visits, and superior scar cosmesis compared with conventional incision and drainage, without a detectable increase in the risk of wound infection or recurrence. It may represent a safe and practical alternative for the surgical management of subcutaneous abscess in this group, although adequately powered studies are needed before firm recommendations can be made.

Journal of Paediatric Surgeons of Bangladesh (2026) Vol. 17 (2): 11-17