Comparison of the loop technique with incision and drainage for soft tissue abscesses: A systematic review and meta-analysis

Am J Emerg Med. 2018 Jan;36(1):128-133. doi: 10.1016/j.ajem.2017.09.007. Epub 2017 Sep 10.


Introduction: Skin and soft tissue infections are a common presentation to the emergency department. Traditional management of abscesses involves a linear incision through the center of the abscess with packing placed. The loop drainage technique (LDT) is an alternate approach that may reduce pain and scarring, as well as decrease the number of follow up visits needed. This systematic review and meta-analysis aimed to compare the efficacy of the LDT with conventional incision and drainage (CID) in the treatment of soft tissue abscesses.

Methods: PubMed, CINAHL, Scopus, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all retrospective, prospective, or randomized controlled trials comparing the LDT to CID with an outcome of treatment failure, as defined by the individual study. Data were double extracted into a predefined worksheet and quality analysis was performed using the Cochrane Risk of Bias tool. Data were summarized and a meta-analysis was performed with subgroup analyses by adult versus pediatric age groups.

Results: This systematic review identified four studies comprising 470 total patients. Overall, the CID technique failed in 25 of 265 cases (9.43%). The LDT failed in 8 of 195 cases (4.10%). There was an odds ratio of 2.63 (95% CI 1.04 to 6.63) in favor of higher failures in the CID group. Funnel plot analysis demonstrated no evidence of publication bias. Subgroups analysis by age group demonstrated improved efficacy of the LDT in pediatric patients, but the adult subgroup did not reach statistical significance.

Discussion: The existing literature suggests that LDT is associated with a lower failure rate than CID. However, the data is limited by small sample sizes and predominantly retrospective study designs. Given the potential for less pain, decreased scarring, and lower associated healthcare costs, this technique should be considered for the treatment of skin and soft tissue abscesses in the ED setting, but further studies are needed.

Keywords: Abscess; I&D; Incision and drainage; Loop drainage; Minimally invasive; Soft tissue infection.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Abscess / surgery*
  • Bandages
  • Drainage / adverse effects
  • Drainage / methods*
  • Humans
  • Soft Tissue Infections / surgery*
  • Treatment Failure