EXTRAFASCIAL WOUND DEHISCENCE - DEEP EN-BLOC CLOSURE VERSUS SUPERFICIAL SKIN CLOSURE

Objective: To determine closure time, pain experienced during closure, and healing time in patients undergoing deep en bloc closure or super ficial skin closure of extrafascial wound dehiscence. Methods: Patient s with extrafascial wound dehiscence on the obstetrics and gynecology service of the University of Mississippi Medical Center were randomize d to deep en bloc closure or superficial skin closure. A 1:2 ratio was used to evaluate superficial skin closure, as deep en bloc closure is known to be effective. The wounds of patients in the deep en bloc gro up were closed with no. 1 polypropylene placed through the entire woun d thickness as simple interrupted sutures. The wounds of patients in t he superficial closure group were closed with 2-0 polypropylene placed through the skin as vertical mattress sutures. The wounds were closed on the patient care unit under local anesthesia. Closure was timed in minutes from initiation of local anesthesia to cutting of the last su ture. Patients assessed pain by placing a mark on a 100-mm line (0 = n one; 100 = maximum). Time for complete healing was measured from wound disruption to skin reepithelialization. Results: During an 8-month pe riod, seven patients were randomized to deep en bloc closure and 16 to superficial skin closure. The en bloc group required 27.1 +/- 5.5 min utes (mean +/- standard deviation) for closure, compared with 18.9 +/- 3.4 minutes in the superficial group (P <.001). The mean pain score i n the en bloc group was 43.4 +/- 23.2 mm, compared with 16.6 +/- 11.4 mm in the superficial group (P < .001). The en bloc group required 22. 7 +/- 7.7 days for complete healing, compared with 19.8 +/- 5.3 days i n the superficial group, a nonsignificant difference. Conclusions: Sup erficial skin closure of extrafascial wound dehiscence appears to be s uperior to deep en bloc closure in terms of closure time and pain expe rienced during the procedure. These benefits are achieved with minimal risk while allowing timely wound healing. (Obstet Gynecol 1994;83:142 -5)