Which Way Would You Slice It? Evaluation of 3 Educational Models for the Loop Drainage Technique

INTRODUCTION

Emergency department visits for cutaneous abscesses are increasing. It is important for healthcare professionals to be proficient in identifying and treating abscesses. Loop drainage technique (LDT) is a newer technique which has been described in several articles but limited resources for teaching have been studied. The objective of this study was to compare 3 models for learning and teaching the LDT.

METHODS

This was a prospective survey study of a convenience sample of emergency medicine residents at a large urban academic center. Residents volunteered to participate during a scheduled cadaver and simulation session. After a self-directed review of the LDT, each participant performed ultrasound visualization and then the LDT on 3 simulated abscesses: a cadaveric model, a commercial abscess pad, and a homemade phantom. Participants completed pre- and post-simulation surveys.

RESULTS

Of 57 residents, 28 participated in the 1-day simulation. The majority (57.1%, p < 0.009) preferred the cadaver model for learning the LDT, and 78.6% reported it to have the most realistic physical examination for an abscess (p = 0.001). Prior to participation, 0% of residents felt proficient performing LDT. After participation, 46.4% of residents felt proficient and 78.6% reported intent to use in clinical practice (p < 0.001).

CONCLUSIONS

Simulation is an effective educational tool for both learning new skills and improving procedural competency. Residents found cadavers provided the most realistic physical examination, and the majority preferred it for learning the LDT. However, cadavers are not always accessible, an important factor when considering various educational settings.

A minimally invasive incision and loop drainage technique for the treatment of lower limb Morel-Lavallée lesions: Nose ring drainage technique

Morel-Lavallée lesions (MLLs) are shearing injuries resulting in separation of the skin and subcutaneous tissue from the underlying fascia. They are closed internal degloving injuries. Classical sites of the lesions are around the greater trochanter, pelvis, thigh, knee joint, and on the head, in decreasing order of frequency. This injury is often delayed or misdiagnosed when patients present with soft tissue injury alone or when more obvious injuries distract from its presence in polytrauma patients. There is currently no universally accepted treatment for these lesions. Conservative management often fails and requires surgical intervention. The purpose of this manuscript is to show that nose ring drainage, a minimally invasive incision and loop drainage technique for the treatment of lower limb Morel-Lavallée lesions, is effective and economical.