SUBCUTICULAR SKIN CLOSURE AS A STANDARD APPROACH TO EMERGENCY APPENDECTOMY IN CHILDREN - PROSPECTIVE CLINICAL-TRIAL

We evaluated the morbidity associated with primary closure by interrup ted subcuticular absorbable sutures following emergency appendectomy. In a prospective clinical trial over a 12-month period, 216 children w ho underwent emergency appendectomy had skin closure using subcuticula r interrupted absorbable polyglactin 4-0 sutures. Preoperative prophyl actic antibiotics consisting of metronidazole alone or in combination with gentamicin were used in patients with suspected phlegmonous appen dicitis; a combination of metronidazole, gentamicin, and ampicillin wa s used when perforation of the appendix was suspected. Postoperatively , in patients with phlegmonous appendicitis metronidazole was given fo r 24 hours, whereas in those with peritonitis the triple antibiotics w ere continued for 7 to 10 days. All patients were assessed for complic ations resulting from the technique of wound closure. No intraabdomina l abscesses or serious complications were recorded. The overall incide nce of wound infection was 1.8%. Among children with a perforated appe ndix the rate of superficial wound infection was 5.7%. There was no di fference in the rate of wound infection between patients who received metronidazole alone or metronidazole plus gentamicin preoperatively. A ll the patients and their families were satisfied with the cosmetic re sults 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.