Removable subcuticular skin suture in acute appendicitis: a prospective comparable clinical trial.

One hundred and eighty-four patients with acute appendicitis were entered into a prospective trial to compare skin wounds closed by a continuous subcuticular Prolene suture with those closed with interrupted Prolene sutures. Only patients with appendicitis subsequently confirmed histologically were included; perforation of the appendix did not contraindicate entry into the trial. All skin incisions were transverse or oblique, and the abdomen was entered through standard grid-iron or transrectus approaches. Drains (17/146; 12 %) and antibiotics (53/146; 35°%) were used at the discretion of the surgeon. Dexon was used for peritoneal and muscle closure in all cases. Neither peritoneal nor wound lavage was performed and, no topical agents were applied to the wound. After closure of the muscle layer a randomly selected sealed envelope was opened to determine the choice of skin suture. The severity of the appendicitis was classified as: (a) acute inflammation, (b) pus present, or (c) perforation. All wounds were examined daily and again two weeks after the patient left hospital; those with a discharge were considered to be infected. Skin sutures were removed between five and seven days after operation. Since 33 patients failed to attend for follow-up and five were excluded because of protocol violations, 146 cases were evaluated. Age ranges were comparable in the two groups of patients: 5-66 years (mean 20-9 years) for those with interrupted sutures and 4-52 years (mean 19 9 years) for those with subcuticular sutures. Wound closed with interrupted sutures and those closed with a subcuticular suture became infected in 15-90% and 1577% respectively; when the appendix was perforated the infection rates were 230o0 and 26 3 (rtl respectively (table). Two wounds closed with an interrupted suture and one with a subcuticular suture required secondary suturing of the skin. In no case did complete wound dehiscence, postoperative intraabdominal abscess, or death occur in either group. The cosmetic appearance of wounds closed with a subcuticular suture was noticeably better than that with interrupted sutures, since cross-scarring was absent.