# Clinical Application of Minimally Invasive Punch and Drainage in the Treatment of Refractory Non-purulent Skin and Soft Tissue Infections: A Case Series

## TL;DR

A minimally invasive punch and drainage procedure helped elderly patients with stubborn skin infections that did not respond to antibiotics.

## Contribution

This case series introduces a minimally invasive procedure for treating refractory non-purulent skin infections in elderly patients.

## Key findings

- All patients showed clinical improvement after the punch and drainage procedure.
- CRP levels significantly decreased postoperatively, indicating reduced inflammation.
- Three patients fully recovered with continued wound care and follow-up.

## Abstract

Non-purulent skin and soft tissue infections (NP-SSTIs) are commonly managed with antibiotic therapy; however, a subset of patients demonstrate inadequate clinical response and develop refractory disease. At present, no standardized minimally invasive procedural intervention exists for the management of refractory NP-SSTIs, and treatment options are particularly limited in elderly patients with multiple comorbidities. We report four cases evaluating a minimally invasive punch and drainage approach in elderly patients with persistent NP-SSTIs that failed to improve despite appropriate antibiotic therapy. These individuals had a mean age of 86.8 years (range, 75-99 years) and presented with ongoing local inflammation, pain, and systemic inflammatory responses accompanied by elevated inflammatory markers. Following unsuccessful antibiotic treatment, all patients underwent a minimally invasive punch and drainage procedure, in which circular punch incisions were created to facilitate drainage of inflammatory material and promote local infection control. Standard postoperative wound care and follow-up were provided. Clinical improvement and effective infection control were observed in all cases without significant perioperative or postoperative complications. Patients were discharged between 7 and 42 days after the procedure. The mean C-reactive protein level decreased from 134.52 mg/L preoperatively to 41.02 mg/L two weeks postoperatively. Three patients achieved complete recovery within approximately two months with continued wound care and outpatient follow-up. One patient demonstrated clinical improvement but later died due to underlying health conditions unrelated to the procedure. These cases demonstrate that minimally invasive punch and drainage can serve as a safe and effective adjunctive treatment for refractory NP-SSTIs and may represent a practical therapeutic option for patients who respond poorly to antibiotic therapy alone.