Subcutaneous Abscess in Children


Subcutaneous abscess are fairly common condition encounter in children. The rise in community cases of methicillin resistant staphylococcus Aureus (MRSA) infection has led to a similar rise in number of  skin infection and abscess formation requiring surgical drainage. These MRSA soft tissue infections often present as more complicated forms of subcutaneous abscess usually necessitating wide incision and drainage procedures for appropriate care. Communities have reported a prevalence of MRSA at 66-74% among pediatric patients undergoing surgical intervention. The toddler population with less than three years of age is at greater risk due to lack of formal toilet training and use of diaper that promotes bacterial propagation. Standard management of subcutaneous abscess, especially those measuring more then five centimeters,  is incision and drainage followed by packing in the wait of secondary healing. Children are unable to perform their own wound care, and caretakers often struggle with wound packing and dressing changes. Minimal invasive technique has been developed to drain these complicated abscess. Intravenous antibiotics are needed when cellulitis and leukocytosis are present. Instead of large drains such as Penrose, small drains such as vessel loops or rubber bands are used to accomplish the task after manipulation of the loculations of the abscess followed by irrigation with normal saline. Vessel loops are used in patients with known latex allergy by all surgeons. The use of a loop drain is safe and effective in the treatment of subcutaneous abscesses in children. Packing gauze is not always needed. Because of the increasing incidence of community-acquired S Aureus soft tissue infections, sulfamethoxazole/trimethoprim or clindamycin, was used empirically for a total of 10 to 14 days. The content of all abscess is swabbed for culture routine, though this not makes a significant process as the results are usually available when the child is recovering from the abscess satisfactorily.

References:
1- Ladd AP, Levy MS, Quilty J: Minimally invasive technique in treatment of complex, subcutaneous abscesses in children.  J Pediatr Surg. 45(7):1562-6, 2010
2- Tsoraides SS, Pearl RH, Stanfill AB, Wallace LJ, Vegunta RK: Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children.  J Pediatr Surg. 45(3):606-9, 2010
3- McNamara WF, Hartin CW Jr, Escobar MA, Yamout SZ, Lau ST, Lee YH: An alternative to open incision and drainage for community-acquired soft tissue abscesses in children.J Pediatr Surg. 46(3):502-6, 2011
4- Leinwand M, Downing M, Slater D, Beck M, Burton K, Moyer D: Incision and drainage of subcutaneous abscesses without the use of packing.  J Pediatr Surg. 48(9):1962-5, 2013
5- Aprahamian CJ, Nashad HH, DiSomma NM, Elger BM, Esparaz JR, McMorrow TJ, Shadid AM, Kao AM, Holterman MJ, Kanard RC, Pearl RH: Treatment of subcutaneous abscesses in children with incision and loop drainage:  A simplified method of care. J Pediatr Surg. 52(9):1438-1441, 2017


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