A Randomized Controlled Study Comparing Incision and Drainage with Deroofing Versus Saucerization for the Treatment of Carbuncle

Abstract

Saucerization is a common treatment for carbuncle is associated with excessive bleeding and prolonged

healing. Incisional and drainage (I&D) is recommended internationally,

however it is not widely practiced locally due to lesion severity at

presentation. We compared I&D with deroofing against saucerization to

treat carbuncle. We prospectively analyzed 59 patients in a

single center for two years duration. All analysis was done based on

intention to treat. Forty-four patients were eligible and randomized to

I&D with deroofing arm (n=21) or saucerization arm (n=23).

I&D with deroofing was associated with shorter

healing time (median 28 days vs 72 days, p=0.003) and less days

requiring dressing change (median 28 days vs 77.5 days, p=0.002).

Saucerization was observed to have higher complications (17.4%; 3

patients required de-sloughing under local and general anesthesia, 1

required blood transfusion), while I&D with deroofing was observed to

have less complications (14.3%; 3 patients required further de-sloughing

under local anesthesia) with shorter operating times although these were

not statistically significant. Staphylococcus aureus was the commonest

organism grown from swab cultures from both arms. I&D

with deroofing should be the treatment of choice in carbuncle due to

significant improvement in healing time and less days required for

dressing change. Future studies on cost effectiveness and effects of age,

diabetes, incisional approach and lesion size on wound healing and

sepsis resolution will provide a better insight on the holistic management

of carbuncle.