Superficial Skin Abscesses Research Articles

En Bloc Excisions of Chronic Abscesses in Bull: A Case Report

Introduction An abscess is the most common swelling observed on the skin surface of the animal body with a collection of pus due to microbial invasion of the dermis and its supporting structures. Case Description In the present case, nine-years-old male Zebu cattle were presented to the Veterinary Teaching Hospital (VTH) with a history of swelling on the cheek. Clinical findings of the mass revealed that there was well-circumscribed, firm, movable cold, and not painful superficial skin swelling on the body of the mandible and check. Culturing on blood agar and gram staining was conducted and then, Corynebacterium pseudotuberculosis was isolated from the sample. Following clinical and laboratory finding the case was diagnosed as caseous lymphadenitis and En bloc excision of the case was performed under local infiltration of anesthesia. Conclusion The suture was removed after 15-days post-intervention and the bull was successfully recovered without any other complications. Therefore, management of well-circumscribed, firm, and movable superficial skin abscess in cattle through en bloc excision along with antibacterial therapy and allowing the skin wound to heal by the first intention should be effective.

Transient cutaneous hypomelanosis after cryoanesthesia.

A superficial skin abscess in a young black female patient was incised after cryoanesthesia with tetrafluoroethane spray. A hypopigmented area was found at the first follow-up visit in the treated skin area; complete repigmentation occurred during the next 4 months. There are no other similar reported cases in the literature. Since long duration and possibly permanent hypopigmentation can occur after cryoanesthesia with tetrafluoroethane, especially in black people, this technique should be used with extreme caution.

Use of a punch biopsy tool as an alternative approach for incision and drainage of abscesses

The incision and drainage of an inflamed or infected cutaneous abscess is a common medical intervention. Traditionally, common practice involves the insertion of a #11 (or similar) scalpel blade to incise an abscess, forming a small linear opening superficially, thus allowing the drainage of purulent contents over several days. Premature skin closure occurs frequently due to the linear wound edges yielding to close approximation. In an effort to avoid this complication, providers often choose to pack the wound. However, randomized controlled trials and meta-analyses have shown no decrease in abscess recurrence rates with wound packing and further suggest postprocedural pain and costs are reduced without wound packing. 1 Mohamedahmed A.Y.Y. Zaman S. Stonelake S. et al. Incision and drainage of cutaneous abscess with or without cavity packing: a systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials. Langenbecks Arch Surg. 2021; 406: 981-991 Crossref PubMed Scopus (4) Google Scholar ,2 Kessler D.O. Krantz A. Mojica M. Randomized trial comparing wound packing to no wound packing following incision and drainage of superficial skin abscesses in the pediatric emergency department. Pediatr Emerg Care. 2012; 28: 514-517 Crossref PubMed Scopus (35) Google Scholar

EP.FRI.537 Post-operative antibiotics for cutaneous abscess after incision and drainage: Variations in Clinical Practice or lack of guidelines

Abstract Aims Acute cutaneous abscess is a common surgical condition which mostly require incision and drainage. Despite this, there is no standardised national or international guidance on the post-operative antibiotics prescription. Traditionally, antibiotics are not indicated unless complications and/or risk factors such as immunocompromisation, diabetes or cellulitis exist. We aimed to study the local practice of the post-operative antibiotics prescription for cutaneous abscesses in a University teaching hospital in London. Methods A retrospective data collection of emergency general surgical admissions for a period of six months from July to December 2020 was carried out. All patients with superficial skin abscess were included in this analysis. Scrotal, breast and limb abscesses were excluded. Patients’ demographics, Co-morbidities, local and systemic complications were studied. Results A total of 149 patients presented during this period. Mean age was 40 (54% were male). Most common site of abscess was perianal (24%), followed by pilonidal, axilla, back, gluteal, neck, abdominal wall and groin. At total of 108 (72.5%) were managed surgically with incision and drainage, 70 (65%) got antibiotics and only 23 (33%) had indications for it (i.e. diabetic, immunocompromised, sepsis, cellulitis, MRSA carriage) = (χ2[1] =22.03, p<.0001). Co-amoxiclav was the most common post-operative empirical antibiotic prescribed in 61% of the patients. Conclusions This study has identified significant variation in clinical practice regarding post-operative antibiotic usage in superficial abscesses. Further research is required in cooperation with microbiologists to develop standardised evidence-based treatment protocol for management of such common surgical condition.

International survey evaluating treatment of primary superficial skin abscesses.

Skin and soft-tissue infections (SSTI) present regularly as cutaneous abscesses which require surgical drainage. These abscesses often affect younger patients and interfere with their independency substantially. Existing guidelines display heterogeneous recommendations concerning surgical aftercare. Primary aim of this survey was to present a nomogram for standard abscess therapy based on international expert opinions. An online survey dealing with standard of care protocols for cutaneous abscesses concerning surgical treatment and aftercarewas created. The survey was conducted in 2017 during two international conferences held in Switzerland. 490 surgeons originating from 66 nations participated in this survey with the majority coming from Europe and Asia. Indication for surgery, operation type, and wound rinsing were answered homogeneously. Perioperative setting (45% sterile, 55% semi-sterile), anesthesia (45% local, 55% general), antibiotic therapy (38% always, 35% never, 27% other), irrigation fluid (54% sterile, 32% non-sterile, 14% antiseptic), irrigation frequency (55% once daily, 30% twice daily), and wound dressing (69% packing, 31% coverage) were heterogeneously answered topics. Treatment and aftercare of simple primary skin abscesses are processed heterogeneously throughout the world. Focus should be on optimal patient focused treatment with minimal socio-economic impact. Future studies should focus on the validation of the different postoperative treatment options with the aim to develop a socio-economically accepted algorithm.

Fast-track ambulatory abscess pathway: an Australian streamlined emergency surgery pathway.

Superficial skin abscesses account for a significant burden of emergency surgical admissions. The aim of this study was to evaluate the effectiveness of an ambulatory care pathway for emergently treating abscesses of the body requiring operative drainage. A retrospective study of a prospective patient database was performed, using randomized patient selection. Patient demographics, length and cost of stay were compared between patients undergoing operative management for skin abscess before and after the implementation of the fast-track ambulatory abscess pathway (FAAP). In total, 100 patients were analysed with 50 in the pre-ambulatory care pathway group and 50 in the FAAP group. The pre-ambulatory care pathway group had a mean age of 37.7 ± 15.8 years versus FAAP group of 35.3 ± 14.5 years. Total length of stay for the group was 85 versus 17 days with a mean comparison of 1.7 days versus 0.34 days (P < 0.001). This translated into a total cost saving of $74 100 in the FAAP group, with a mean comparison cost between the groups of $2884 versus $1402 (P < 0.001). Both reductions in length of stay and cost of stay were statistically significant after implementation of the pathway. This is the first Australian study to report the findings from an ambulatory care pathway for an emergency surgical intervention. We have shown that skin abscesses presenting through emergency can be managed as a day-case procedure, thereby decreasing these patients' overall length and cost of stay.

Pilot Study to Evaluate the Adjunct Use of a Povidone-Iodine Topical Antiseptic in Patients with Soft Tissue Abscesses.

Povidone-iodine (PVP-I) antiseptic solutions have been shown to be effective against methicillin-resistant Staphylococcal aureus, a common cause of superficial skin abscesses. Our objective was to study the feasibility of using PVP-I as a treatment adjunct in patients with superficial skin abscesses and determine if it confers any benefit over incision and drainage (I&D) alone. This was a randomized controlled pilot study of adult patients with an uncomplicated skin abscess. Patients were randomized to PVP-I or standard treatment. All patients had I&D and abscess packing. Patients randomized to PVP-I were instructed on daily application of the agent to hands, wound, and surrounding skin with dressing changes. Subjects returned at 48-72h and 7-10days and followed-up by phone at 30days. The primary outcome was clinical cure 7-10days after I&D. The secondary outcomes were rate of development of new skin lesions and spread in household contacts within 30days. Clinical cure occurred in 91.3% of patients in the standard group vs. 88.2% of patients in the PVP-I group (difference, 3.1%; 95% confidence interval [CI] -10.7 to 16.8; p=0.53). There was a significantly higher adverse event rate in the group who received PVP-I (59.6%) vs. standard care (26.5%) (difference 33.1%, 95% CI 13.2-50.2; p<0.001). There was no difference in clinical cure rates among patients using PVP-I (88.2%) vs. standard care (91.3%) after I&D. There were no major adverse events, but the addition of PVP-I was commonly associated with local skin irritation.

Neonatal sepsis and multiple skin abscess in a newborn with Down’s syndrome: A case report

Neonatal sepsis is a leading cause of neonatal mortality. Congenital heart disease accounts for additional risk of sepsis in neonates. Here we report a case of Down's syndrome with late onset neonatal sepsis associated with multiple superficial skin abscesses simulating staphylococcal infection. The baby was empirically treated with vancomycin. Subsequently, multidrug resistant Klebsiella pneumoniae was detected from both pus and blood culture. Change to appropriate antibiotic resulted in clinical recovery. Although sepsis is one of the major ailments in neonates, atypical presentations of neonatal sepsis in Down's syndrome patients are underreported. Here we highlight the atypical presentation of Klebsiella sepsis and the importance of early antibiogram in such cases.

Randomized Trial Comparing Wound Packing to No Wound Packing Following Incision and Drainage of Superficial Skin Abscesses in the Pediatric Emergency Department

The objective of this study was to investigate the impact of wound packing versus no wound packing on short-term failure rates and long-term recurrences after incision and drainage (I&D) of a simple cutaneous abscess. In this randomized, single-blind, prospective study, subjects between the ages 1 and 25 years with skin abscesses needing an I&D were enrolled consecutively and randomized to be packed or not packed following the procedure. Treatment failure was assessed at a 48-hour follow-up visit by a masked observer who rated the need for a major intervention (repeat I&D or re-exploration) or minor intervention (antibiotics initiated or changed, need for packing, or repeat visit). Pain scores were assessed using color analog scales before and after the procedure and repeated at the 48-hour follow-up visit. Healing and abscess recurrence were assessed via telephone interview at 1 week and 1 month. Fifty-seven subjects were enrolled over a 15-month period. Overall failure rates were similar between the groups, with 19 (70%) of 27 subjects in the packed group needing an intervention by 48 hours compared with 13 (59%) of 22 subjects in the nonpacked group who needed an intervention (difference, 11%; 95% confidence interval, -15% to 36%). Major and minor intervention rates were also similar. Pain scores did not significantly differ between groups. Wound packing does not appear to significantly impact the failure or recurrence rates after simple I&D. Larger studies are needed to better validate the equivalency of these 2 strategies.

Homemade ultrasound phantom for teaching identification of superficial soft tissue abscess

BackgroundPoint-of-care ultrasonography (POCUS) is often used to distinguish abscess from cellulitis in superficial soft tissue infections. With the increased use of POCUS in emergency medicine, it is important that training...

The Limited Role of Microbiological Culture and Sensitivity in the Management of Superficial Soft Tissue Abscesses

The aim of this study was to assess the role of the routine practice of microbial culture and sensitivity at incision and drainage of superficial soft tissue abscesses. The case notes of 162 consecutive patients, selected from the microbiology database over a period of 1 year, were reviewed. All had incision and drainage of superficial soft tissue abscesses and included perianal, pilonidal, axillary, and breast abscesses. Patients with chronic wounds, recurrent abscesses, diabetes, pregnancy, and immunosuppression were excluded. The impact of pus culture and sensitivity (C/S) on management and clinical outcome was documented. Out of 162 patients, 97 were male (59.8%) and 65 were female (40.1%). Only 115 (70.9%) yielded positive cultures and 47 (29.1%) were sterile. The cultured microbial flora was predictable and sensitive to empirical antibiotics. In four patients, the results of microbial culture sensitivity showed microbial resistance to empirical antibiotics; however, it did not affect the management or the outcome for these patients. The routine practice of sending swabs for C/S after incision and drainage of superficial soft tissue abscesses does not contribute significantly towards patient management. Most patients are already on antibiotics prior to the referral and in the remainder, surgeons start antibiotics empirically. These broad-spectrum antibiotics cover the common pathogens involved, and there is no significant change in the antibiotic treatment after reviewing the culture reports following incision and drainage of uncomplicated superficial skin abscesses.

Kerosene-Induced Epidural Abscesses

To the Editor. —Spinal epidural abscess is usually caused by pyogenic bacteria or mycobacteria. We describe a case of sterile epidural abscess caused by local kerosene injection. Report of a Case. —A 22-year-old woman was referred to our medical center for a sudden onset of weakness of both legs. The paraparesis appeared while the patient was receiving antibacterial and surgical therapy for superficial skin abscesses. On admission, her temperature was 39 °C, and her WBC count was 23,000/cu mm, with 30% bands. Paraplegia of both legs and sensory loss below D-8 were noted. She had several incisions in abscess sites that were healing. Myelography disclosed a complete blockage at D-12. During the operation, a large suppurative process was found occupying the subcutaneous tissues, the facial planes, the muscles, and the epidural space between D-10 and L-2. Laminectomy was performed. Gram's, acid-fast, and india ink stains were all negative. Antistaphylococcal and

Anaphylactic Reaction To γ-globulin

To the Editor:— A 7-year-old white boy has been under my care for approximately 4 1/2 years, because of repeated upper-respiratory tract infections, and episodes of tonsilitis, somewhat helped by tonsillectomy at the age of 4. Additional complications have been nonspecific croup, bronchopneumonia, and superficial skin abscesses. Frequent and severe otitis media has usually been a consequence of an upper-respiratory tract infection. The boy would complain of pain in one ear in the morning, and, despite immediate administration of decongestants and antibiotics, perforation of the ear drum would take place in six to seven hours. This happened four or five times in four years, in addition to attacks of otitis media without perforation at least once a month. Otologic and other studies have reported only perennial nasopharyngitis of infectious origin. Cultures of nasopharyngeal and ear exudates have yielded Haemophilus influenzae, Staphylococcus aureus , coagulase positive, pneumococci, and streptococci of the viridans