Outcomes of skin closure with suture materials in clean paediatric surgical procedures

Except through natural orifices, all surgical operations involve making skin incisions which are often closed with suture materials to which the skin may react. This is a five-year (2005-2009) retrospective study of postoperative outcomes of 998 clean skin incisions closed with continuous subcuticular suture materials in 796 children at two Nigerian centres. The children were aged between 1 day and 18 years (mean 6.5 +/- 3.4 years) with a male to female ratio of 2.5:1. The location of the incisions ranged from groin in 678 (67.9%) cases to lower limbs in 15 (1.5%), these were associated with 414 (61.1%) and 13 (86.7%) postoperative complications respectively. Sutures were not removed from the skin in 734 cases and were associated with 558 (76%) postoperative complications whereas sutures were removed between 5-7 postoperative days in 264 cases and were associated with 39(14.8%) postoperative complications (P < 0.0001). Whereas postoperative wound infection in 69 (6.9%) cases occurred before ten days, stitch abscess/sinus, 156 (15.6%), suture extrusion, 80 (8%), hyperpigmentation, 211 (21.1%), pruritus, 182 (18.2%), hypertrophied scars, 128 (12.8%), and keloid formation, 9 (0.9%), occurred after the tenth postoperative day among those whose sutures were not removed in direct proportion to patients' age/ suture size. These postoperative complications gave rise to 343 (34.3%) good, 245 (24.5%) fair, and 9 (0.9%) poor cosmetic outcomes, whereas 401 (40.2%) incisions without postoperative complication gave excellent cosmetic outcomes. It is suggested from this study that continuous subcuticular suture materials which should be removed not later than the tenth postoperative day be used for skin closure in children.