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Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial
1Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
Insights
Primary closure with absorbable sutures after emergency appendectomy in children is safe and effective. This method resulted in low wound infection rates and high patient satisfaction, eliminating the need for suture removal.
Area of Science:
- Pediatric Surgery
- Surgical Wound Management
Background:
- Emergency appendectomy is a common pediatric surgical procedure.
- Wound closure techniques impact postoperative morbidity and patient outcomes.
Purpose of the Study:
- To evaluate the morbidity associated with primary skin closure using interrupted subcuticular absorbable sutures after emergency appendectomy in children.
- To assess the safety, efficacy, and cosmetic results of this closure technique.
Main Methods:
- A prospective clinical trial involving 216 children undergoing emergency appendectomy.
- Skin closure utilized interrupted absorbable polyglactin 4-0 sutures in a subcuticular manner.
- Prophylactic antibiotic regimens were administered based on suspected appendicitis severity (phlegmonous vs. perforated).
Main Results:
- Overall wound infection rate was 1.8%; superficial wound infection rate was 5.7% in children with perforated appendix.
- No intra-abdominal abscesses or serious complications were recorded.
- High patient and family satisfaction with cosmetic results and avoidance of suture removal.
Conclusions:
- Primary closure with interrupted absorbable subcuticular sutures is a safe and effective method for emergency appendectomy in children.
- The use of prophylactic antibiotics supports this standard skin closure technique.
- This approach offers excellent cosmetic outcomes and improves patient experience by eliminating suture removal.
Abstract:
We evaluated the morbidity associated with primary closure by interrupted subcuticular absorbable sutures following emergency appendectomy. In a prospective clinical trial over a 12-month period, 216 children who underwent emergency appendectomy had skin closure using subcuticular interrupted absorbable polyglactin 4-0 sutures. Preoperative prophylactic antibiotics consisting of metronidazole alone or in combination with gentamicin were used in patients with suspected phlegmonous appendicitis; a combination of metronidazole, gentamicin, and ampicillin was used when perforation of the appendix was suspected. Postoperatively, in patients with phlegmonous appendicitis metronidazole was given for 24 hours, whereas in those with peritonitis the triple antibiotics were continued for 7 to 10 days. All patients were assessed for complications resulting from the technique of wound closure. No intraabdominal abscesses or serious complications were recorded. The overall incidence of wound infection was 1.8%. Among children with a perforated appendix the rate of superficial wound infection was 5.7%. There was no difference in the rate of wound infection between patients who received metronidazole alone or metronidazole plus gentamicin preoperatively. All the patients and their families were satisfied with the cosmetic results and with the fact that removal of skin sutures was unnecessary. We conclude that the use of prophylactic antibiotics permits standard skin closure by interrupted absorbable subcuticular suture.