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Wound dehiscence with continuous versus interrupted mass closure of transverse incisions in children with absorbable suture: a randomized controlled trial
  1. Safwan Khan1,
  2. Muhammad Saleem2 and
  3. Nabila Talat2
  1. 1Department of Pediatric Surgery, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia
  2. 2Department of Pediatric Surgery, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
  1. Correspondence to Dr Safwan Khan; safwan364{at}gmail.com

Abstract

Introduction Numerous meta-analyses done on adults suggest superiority of continuous mass closure technique, but any such study does not exist for the pediatric age group. The results in adults cannot be applied to pediatrics because of numerous physiologic and anatomic differences.

Methods This is a single-blinded, randomized controlled trial, 1:1 parallel groups, that compares the frequency of dehiscence between the interrupted and continuous mass closure techniques for transverse incisions in pediatric patients. The age range was from birth to 12 years. We sampled 350 patients undergoing emergency or elective exploratory laparotomies in our pediatric surgery unit. Blocked randomization was used and only the patients remained blinded during the intervention. One group was closed with interrupted mass closure (group A) and the other group with continuous mass closure technique (group B). We had to drop 50 patients for not meeting the inclusion criteria.

Results The wound dehiscence rate for group A was 1.34% (4 patients) and for group B was 3.0% (9 patients). Significance was calculated using χ2 (p<0.156). The global wound dehiscence rate was 4.34% (13 patients). The maximum number of patients dehisced on the fifth postoperative day, while the range was 4–11 days. The only statistically significant confounding factor was wound classification (p<0.002).

Discussion Statistically there is no significant difference between interrupted and continuous mass closures techniques in terms of wound dehiscence. The dirty wounds are at a maximum risk of developing wound dehiscence irrespective of the technique used. We need to strictly adhere to the basic principles of closure especially when dealing with dirty wounds.

Trial registration number TCTR20150318001.

  • pediatric mass abdominal closure
  • pediatric abdominal wound dehiscence
  • pediatric interrupted mass abdominal closure
  • pediatric continuous abdominal mass closure

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Footnotes

  • Contributors All authors had substantial contribution to the conception and design of the work, including acquisition, analysis, and interpretation of data. Drafting the work was done by SK, while revising it critically for important intellectual content was done by MS and NT. Final approval of this version was given by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note The corresponding author was working at the Department of Pediatric Surgery, The Children’s Hospital and The Institute of Child Health during the conduct of the study. Now he has moved to the Department of Pediatric Surgery, Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia.

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