Use of a Novel Zipper Device for Wound Closure of Cutaneous Abscesses in Pediatric Outpatients: A Case Series

Background. Current management of pediatric cutaneous abscesses involves either spontaneous healing by secondary intention or suturing through tertiary intention, which are often lengthy processes that cause discomfort and distress among children. As it is noninvasive and simple, a novel zipper device is widely used for the primary wound closure of surgical incisions. Objective. To describe the effectiveness of novel zipper device use for pediatric cutaneous abscess wound closure in an outpatient context. Materials and Methods. A total of 26 pediatric outpatients with simple cutaneous abscesses were included. After incision and drainage (I&D), the novel zipper device was applied once pus decreased significantly and fresh granulation tissue emerged. Wound healing time and pain score were tracked over the intervention period. Linear regression and restricted cubic spline models were also used to analyze the relationship between the intervention interval of time from I&D to zipper application and wound healing time. Results. The average (SD) wound healing time was 12.73 (3.16) days. Pain scores decreased significantly from a median of 2 during zipper use to 0 at removal. Linear regression analysis revealed 2 healing time predictors: infection size (B = 0.260, SE = 0.090, β = 0.260, t = 2.924, P = .008) and intervention interval of zipper use (B = 0.850, SE = 0.090, β = 0.810, t = 9.187, P = .001). A linear dose-response relationship was observed between intervention interval and healing time (Ptotal < .001, Pnonlinear = .406). Conclusion. This case series identifies the fifth day post-I&D as a potential threshold, and suggests that the optimal period of zipper device use is 3 days to 5 days following I&D of skin abscess to enhance early wound healing, beyond which extended intervention intervals prolong wound healing time.