(68) Loop Drains for Treatment of Vulvar Abscess: A Case Series.

Background: Vulvar abscesses have traditionally been treated with incision and drainage and daily packing change. Loop drains have effectively been used in the Emergency Department to treat soft tissue abscesses. In this case series we describe a novel approach to the treatment of two patients with vulvar abscesses with silicone vessel loops.

Case: A 19-year-old female with poorly controlled diabetes presented with vulvar pain. On exam, the right labia majora was indurated and tender. She was admitted for intravenous antibiotics and management of diabetic ketoacidosis. MRI pelvis showed a 5.2 x 0.9 x 1.2 cm labial abscess. Incision and drainage was performed and packing placed in the operating room. A vessel loop was placed in a smaller collection of pus superiorly and tied on the skin (Figure1). Packing was removed on post-operative day #1. Antibiotic coverage was narrowed for coverage of group B streptococcus which grew on culture. However, two days later increased pain and fluctuance returned and ultrasound showed development of a 2.7 cm abscess in area of prior packing. Two additional vessel loops were placed using ultrasound guidance in the operating room. One week later, 2 loops fell out. The remaining loop was removed in clinic 18 days after placement when pain was markedly improved, and drainage has resolved.

A 17-year-old female presented with right vulvar pain and an enlarging cystic mass. Ultrasound revealed a 2.1 x 2.1 x 1.8 cm labial abscess. She received intravenous clindamycin and was taken to the operating room for incision and drainage. In the OR, two incisions were created to allow for drainage and threading of a 2.1 x 1.2 mm vessel loop, which was tied on to the skin. A culture of the drainage returned as normal urogenital flora. Figure 2 demonstrates the technique for placing a vessel loop drain. At her post-operative appointment, she reported no further pain or fluctuance, and the loop drain was removed.

Comments: Loop drains provide an effective, patient-friendly alternative for treating vulvar abscesses. They eliminate the need for painful wound packing and minimize scarring, resulting in a more comfortable recovery. Silicone loops are soft, flexible, and cause minimal discomfort while remaining in place during healing. Their design reduces follow-up visits since no packing changes are needed, enhancing convenience and recovery. Loop drains are easy to place and allow for a quick, simple removal which can be done at the bedside by any healthcare provider.