COMPARATIVE STUDY BETWEEN INTERRUPTED MATTRESS AND CONTINUOUS SUBCUTICULAR SKIN CLOSURE IN REGARDING POST-APPENDECTOMY WOUND INFECTION

Historically, potentially infected surgical wounds, like in acute appendicitis, were recommended to be closed by interrupted skin suturing. However, this method of skin closure can leave a marked scar at the closure site after healing of the wound. On the other hand, there are no enough data about the potential risk increment in wound infection following skin closure by continuous subcuticular approach. This is a prospective study aimed to compare the results of skin closure using interrupted mattress and subcuticular continuous approaches following appendectomy, in terms of postoperative wound infection rates. One hundred and ten (110) patients with acute appendicitis admitted to Al-Sadir Teaching Hospital in the period between January 2013 and February 2014 were chosen for the study. The patients were divided into two groups. In one group, (58) patients, the appendectomy wound was closed by interrupted mattress, and patients in the other group, (52) patients, underwent continuous subcuticular skin closure. All patients were followed up for two days postoperatively in the hospital and seven days as outpatient follow-up for signs and symptoms of wound infection. By assessing the effect of risk factors on the rate of post-appendectomy wound infection, the following results were obtained: Effect of gender on postoperative infection: Males: 8/59 (13.6%), Females 6/51 (11.8%), P value: 0.079. So the association between gender and rate of infection was not significant. Effect of smoking on postoperative infection: Smokers: 4/24 (16.7%), Non-smokers: 10/86 (11.6%), P value: 0.429. So the association between smoking and the rate of infection was not significant. Effect of family history of previous appendectomy on postoperative infection: Positive family history: 7/34 (20.6%), Negative family history: 7/76 (10.1%), P value: 2.738. So the association between family history and the rate of infection was not significant. Effect of history of previous abdominal operations on postoperative infection: Positive history: 1/7 (16.7%), Negative history: 13/103 (12.6%), P value: 0.066. Thus the association between history of previous abdominal operations and the rate of postappendectomy wound infection was not significant. In interrupted mattress skin closure group, 7/58 (12%) patients developed signs and symptoms of wound infection, whereas in the continuous subcuticular skin closure group, 7/52 (13.4%) patients developed wound infection. In conclusion, there is no significant difference in the risk of wound infection between skin closure by interrupted mattress and continuous subcuticular approaches. Introduction A cute appendicitis is a very common emergency condition, especially among young patients, with incidence of about 8.6% in males and 6.7% in females worldwide. The highest incidence of acute appendicitis is found in persons aged 10–19 years, with higher incidence in males than females. It requires surgical intervention to remove the inflamed appendix. Thus, appendectomy represents one of the most common abdominal operations performed in surgical units.