Derma-Stent Novel Abscess Packing Device
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 90 |
| Updated: | 6/2/2017 |
| Start Date: | March 27, 2017 |
| End Date: | December 15, 2017 |
| Contact: | Patrick Medado |
| Email: | pbmedado@med.wayne.edu |
| Phone: | 313-745-4621 |
Derma-Stent Novel Abscess Packing Device (Pilot Study)
In this research study, a device called the Derma-Stent will be tested. The sponsor of the
study, Mar-Med Company, will supply the device. This device is used to drain a cutaneous
abscess, which is a skin infection that results in buildup of pus under the skin. Currently,
the normal treatment for this abscess is to cut and drain and the wound, and later pack the
wound with gauze. Packing is done to prevent the pus to accumulate again. But regular gauze
is difficult for patient to remove themselves, so another visit to the doctor is usually
necessary. The Derma-Stent device will be tested to see how easily patients can remove this
by themselves and if it is less painful and more effective than normal gauze packing.
study, Mar-Med Company, will supply the device. This device is used to drain a cutaneous
abscess, which is a skin infection that results in buildup of pus under the skin. Currently,
the normal treatment for this abscess is to cut and drain and the wound, and later pack the
wound with gauze. Packing is done to prevent the pus to accumulate again. But regular gauze
is difficult for patient to remove themselves, so another visit to the doctor is usually
necessary. The Derma-Stent device will be tested to see how easily patients can remove this
by themselves and if it is less painful and more effective than normal gauze packing.
Background:
Cutaneous abscess is an infectious condition that affects millions of people each year, and
the incidence is on the rise. Between 1993 and 2005, the annual number of emergency
department (ED) visits for skin and soft tissue infections increased from 1.2 to 3.4
million, and this largely attributed to a rise in the prevalence of Methicillin Resistant
Staphylococcus Aureus (MRSA) in the community.
The standard treatment for cutaneous abscess is incision and drainage at bedside in the ED.
Following this procedure, many clinicians insert a strip of gauze, known as packing, to
maintain the open surgical incision, enhance drainage, and prevent re-accumulation of the
abscess. If the abscess is packed, patients typically have to return in 2-3 days for a
repeat visit to have the packing removed. The present standard of care, gauze packing, is
difficult for patients to remove alone, as the packing itself becomes impregnated with pus
and blood. Additionally, the packing procedure can be painful, despite the use of local
anesthetics.
A newer approach advocates for the use of a silicon string, known as a PDS loop for purposes
of packing and drainage. While this approach can reduce pain, and is equally effective in
terms of healing time, and treatment failure, the PDS, or Vessiloop is not readily available
in emergency departments and outpatient clinics, as it is a specialized sterile surgical
device used in vascular procedures. Furthermore, this procedure does not facilitate
irrigation of the abscess cavity, since a much smaller incision is made. Finally, the PDS
loop requires a surgical knot which may come loose.
Objective:
To investigate the use of a novel silicon packing device, the Derma-Stent™. The novel device
will facilitate self removal by patients, as it has a narrower profile, and, as a
nonabsorbent material, will not become saturated with bodily fluids. Although it will not
absorb body fluids, it is believed that the Derma-stent will achieve the objective of wound
healing by maintaining the opening of the surgical incision.
Hypothesis:
The acceptability of self removal will be significantly higher for the novel device.
Study Protocol:
ED Visit
1. Abscess measured by ultrasound. Study will be performed by a trained research
assistant, and will be verified by a physician certified to interpret soft tissue
sonographic images.
2. Abscess photographed, with measurement tape, to allow for objective measurement of skin
induration and erythema.
3. Abscess will be incised and drained, utilizing standard of care technique, with local
anesthetic
4. Packing performed according to randomization group.
5. Sterile dressing applied.
6. Subject completes assessment form - pain scale.
7. Practitioner fills out assessment form - ease of use.
Follow up visit 1 - 3-5 days
1. Removal of packing. Subjects will be asked to remove packing on their own under
supervision of the physician. Physician will remove the packing if they not able to.
2. Measurement of abscess diameter and volume, utilizing measuring tape, photograph, and
point of care ultrasound.
3. Practitioner and subject assessment form as above, but adding ease of procedure, and
likelihood that subject would have removed packing at home.
Follow up visit 2 - 24-32 days
1. Assessment of residual erythema and fluid collection by measurement, photograph, and US
2. Practitioner and subject assessment including global satisfaction, and satisfaction
with cosmetic result.
Adverse Effects:
If physician is impressed that the wound is not appropriately at either f/u visit,
antibiotics may be prescribed, and repacking may be performed, utilizing gauze packing
strip. Use of antibiotics for abscess is controversial and most physicians prescribe these
on a case by case basis. Antibiotics will be prescribed at the discretion of the physician
and not related to the study protocol.
Population:
Convenience sample of adult patients presenting with uncomplicated cutaneous abscess
amenable to bedside drainage to either DRH or SGH ED.
Sample size calculation:
As this is a hypothesis generating study, and the effect size is unknown, formal sample size
calculation was not performed. 60 patients was chosen as the sample size.
Cutaneous abscess is an infectious condition that affects millions of people each year, and
the incidence is on the rise. Between 1993 and 2005, the annual number of emergency
department (ED) visits for skin and soft tissue infections increased from 1.2 to 3.4
million, and this largely attributed to a rise in the prevalence of Methicillin Resistant
Staphylococcus Aureus (MRSA) in the community.
The standard treatment for cutaneous abscess is incision and drainage at bedside in the ED.
Following this procedure, many clinicians insert a strip of gauze, known as packing, to
maintain the open surgical incision, enhance drainage, and prevent re-accumulation of the
abscess. If the abscess is packed, patients typically have to return in 2-3 days for a
repeat visit to have the packing removed. The present standard of care, gauze packing, is
difficult for patients to remove alone, as the packing itself becomes impregnated with pus
and blood. Additionally, the packing procedure can be painful, despite the use of local
anesthetics.
A newer approach advocates for the use of a silicon string, known as a PDS loop for purposes
of packing and drainage. While this approach can reduce pain, and is equally effective in
terms of healing time, and treatment failure, the PDS, or Vessiloop is not readily available
in emergency departments and outpatient clinics, as it is a specialized sterile surgical
device used in vascular procedures. Furthermore, this procedure does not facilitate
irrigation of the abscess cavity, since a much smaller incision is made. Finally, the PDS
loop requires a surgical knot which may come loose.
Objective:
To investigate the use of a novel silicon packing device, the Derma-Stent™. The novel device
will facilitate self removal by patients, as it has a narrower profile, and, as a
nonabsorbent material, will not become saturated with bodily fluids. Although it will not
absorb body fluids, it is believed that the Derma-stent will achieve the objective of wound
healing by maintaining the opening of the surgical incision.
Hypothesis:
The acceptability of self removal will be significantly higher for the novel device.
Study Protocol:
ED Visit
1. Abscess measured by ultrasound. Study will be performed by a trained research
assistant, and will be verified by a physician certified to interpret soft tissue
sonographic images.
2. Abscess photographed, with measurement tape, to allow for objective measurement of skin
induration and erythema.
3. Abscess will be incised and drained, utilizing standard of care technique, with local
anesthetic
4. Packing performed according to randomization group.
5. Sterile dressing applied.
6. Subject completes assessment form - pain scale.
7. Practitioner fills out assessment form - ease of use.
Follow up visit 1 - 3-5 days
1. Removal of packing. Subjects will be asked to remove packing on their own under
supervision of the physician. Physician will remove the packing if they not able to.
2. Measurement of abscess diameter and volume, utilizing measuring tape, photograph, and
point of care ultrasound.
3. Practitioner and subject assessment form as above, but adding ease of procedure, and
likelihood that subject would have removed packing at home.
Follow up visit 2 - 24-32 days
1. Assessment of residual erythema and fluid collection by measurement, photograph, and US
2. Practitioner and subject assessment including global satisfaction, and satisfaction
with cosmetic result.
Adverse Effects:
If physician is impressed that the wound is not appropriately at either f/u visit,
antibiotics may be prescribed, and repacking may be performed, utilizing gauze packing
strip. Use of antibiotics for abscess is controversial and most physicians prescribe these
on a case by case basis. Antibiotics will be prescribed at the discretion of the physician
and not related to the study protocol.
Population:
Convenience sample of adult patients presenting with uncomplicated cutaneous abscess
amenable to bedside drainage to either DRH or SGH ED.
Sample size calculation:
As this is a hypothesis generating study, and the effect size is unknown, formal sample size
calculation was not performed. 60 patients was chosen as the sample size.
Inclusion Criteria:
1. ED patient > 18, < 90.
2. Abscess total dimensions (z+y+z) by ultrasound greater or equal to 5 cm.
3. Consent to participate in research protocol.
4. Assessment by attending physician that the abscess will require packing.
Exclusion Criteria:
1. Patients requiring admission for skin and soft tissue infection.
2. Abscess drainage requiring procedural sedation.
3. Abscesses requiring incision and drainage in the operating room.
4. Inability to comprehend consent and follow up instructions.
5. Prisoners.
6. Pregnant women.
We found this trial at
1
site
5050 Anthony Wayne Dr
Detroit, Michigan 48201
Detroit, Michigan 48201
(313) 577-2424
Phone: 313-577-1216
Wayne State University Founded in 1868, Wayne State University is a nationally recognized metropolitan research...
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