Wound dehiscence with continuous versus interrupted mass closure of transverse incisions in children with absorbable suture: a randomized controlled trial

Abstract

IntroductionNumerous 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.MethodsThis 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.ResultsThe 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).DiscussionStatistically 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 numberTCTR20150318001.